HomeMy WebLinkAboutPocahontas Resort_14000180149000_Shoreland Permits_w ---
APPLICATION FOR SITE PERIKIIT
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537
www.co.otter-tail.mn.us
\m\7E - Office
GOLDENROD - Inspector
YELLOW - Owner (after issue)
PINK - Assessor
■V
PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
!
TWP NAMERANGETWP NO.SECTIONLAKE/RIVER
CLASSLAKE/RIVER NAME, LAKE / RIVER NO.^InfWl HOpg-iAiO
PROPERTY (E-911) ADDRESS/ Y ''C/OO ' - c7£7 6 > ' 0 o I
/H''0O0 -^-O(^(^ -OOP
. PARCEL NUMBER (S)
3fo3y g /tCv 35
LEGAL DESCRIPTION
L I ■
Daytime Phone No.Mailing AddressFirst InitiaiLast Name
Cii^lc CilleKt e.Property
Owner
. Contractor
' Name
Lie. It
ONSITE SEWAGE
TREATMENT SYSTEM
PROPOSED PROJECT (please circle the appropriate number)
-(1 ) New Dwelling
(4) MH/YR____
. (7 ) Add’n.To Non-Dwelling ( 8 ) Storage Structure
- '10) Other,
ONSITE WATER SUPPLY
^^^ndividual ( ) Public ( ) None
NOTE; MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
(3 ) *Replacement Dwelling
etached Garage lAA.e^Ue
( 9 ) W.O.A.S.
(2 ) Add’n to Dwelling
( 5 ) RCU/Year_____
^Permit No.____/ / 3>
( ) OTLSD * This permit is oniy valid after verification ■ ,
from the O.T.L.S.D. that a conforming
sewage system will be installed to service
this iol contact Rollie Mann at 864-5533.’Existihg Dwelling to be removed before.
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS'OF PROPOSED DWELLING
■ OutsideDimension____
Sq: Ft.
Setback to Lotline
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
Dimension _Ft."Ft. X Ft."Ft."Ft. X52LSq. Ft.
Setback to Lotline
Setback to Right of Way
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level /Si Ft.
Setback to Septic Tank ^0 Ft.
Setback to Drainfield /O Ft.
So"-Sq. Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff____
hoFt.&Ft."Ft."Ft.&Ft."Ft.&^ 5'Ft."'■ Setback to Right of Way ’
Setback to Ordinary High Water Level __Ft."Ft.Ft.
Elevation Above Ordinaiy High Water Level
Setback to Septic Tank
Setback to Drainfield _
Ft.Ft.
. Ft.Ft.
Ft.Ft.
Ft.Setback to Bluff_______
Maximum Proposed Height
Basement_____
Walkout Basement
Total Bedrooms_
Ft.Ft.Setback to Bluff
Maximum Proposed Height _
Bathroom Proposed ( ) Yes
Ft..Ft./ V FtNoYes
.Ft.Maximum Proposed Height
( ) Boathouse
( ) Gazebo
*7Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / inspection
Yes No ^No
( ) Screen Porch
( ) Storage Structure
* Must include on scale drawing
Permit may be required
Topographical Alteration / Earthmovinq
.□ -None ^^20 Cubic Yards or Less ' □ 21 Cubic Yards - 299 Cubic Yards’
CHARACTEmSriCS OF LOT:
□ 300 Cubic Yards or More*
-K.YesLot Area_.Ft.Bluff NoSq. Ft.Water Frontage
Impervious Surface Ratio:X100 =Impervious Surface RatioTotal Impervious Surface Onsite (FT^)Total Lot Area (FT')
THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance vyith the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
. a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
■condition that,the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County,'
■ Minnesota. This permit may be revoked at any time upon violation of said Ordinances.
I uhde^tand that it is my ri ibility to inform the Land & Resource Management office once the building footings have been constructed.
10.1.02 ,C' Date:
yignature ol /nei
r/^ bate:
Land & Rd^^rce Management OJ^
576 /SO —PERMIT FEE $RECEIPT NO.PROJECT(S) TOTAL SQ. FT.,
Comments:
Form No. BK — 0203-0501 313,012 • Victor Lundeen Co., Printers • Fergus Falls', Minnesota^'
'rY
r
WHITE - (jifice
GOLDENROD - Inspector
YELLOW - Owner (after issue)
PINK - Assessor
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537
www.co.otter-tail.mn.us Ckf/ohlt3
9^01^ X.Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
TWPNO.RANGE TWP NAMELAKE/RIVER
CLASS
SECTIONLAKE / RIVER NO.LAKE/RIVER NAME
Sli'irvt O
PROPERTY (E-911) ADDRESSooc'<^i'OGPARCEL NUMBER (S)
Ccr /X-y/^ooo oocy .1
LEGAL DESCRIPTION
?
Daytime Phone No.Mailing AddressFirst InitiaiLast Name
: I ij' 7'.^fouc^u-,/s/7 iC /c cProperty
Owner
•-V
aa/^
Contractor
Name
Lie.#i
7
ONSITE SEWAGE
TREATMENT SYSTEM
'(jQ Permit No.
( ) OTLSD * TNs permit is only valid after verification
from the O.T.L.S.D. that a conforming
sewage system will be Installed to service
this lot contact Rollie Mann at 864-5533.
ONSITE WATER SUPPLY
( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
PROPOSED PROJECT (please circle the appropriate number)
( 2 ) Add’n to Dwelling
( 5 ) RCU/Year_____
(7 ) Add'n To Non-Dwelling (8 ) Storage Structure
(10) Other.
^Individual
( 3 ) 'Replacement Dwelling
Garage
'■’“•I—^ (AA cJC(9)W.0.A.S.
(1 ) New Dweiling
( 4 ) MH/YR____■ ■ ■'j f—^
'Existing Dwelling to be removed before.
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
Dimension
CHARACTERISTICS OF PROPOSED DWELLING
Outside
Dimension Q H Ft. X ^Ft."Ft. X Ft."Ft. X Ft."S7LSq. Ft.
Setback to Lotiine ___
Setback to Right of Way
Setback to Ordinary High Water Level ___
Elevation Above Ordinary High Water Level
Setback to Septic Tank__
Setback to Drainfield____
Setback to Bluff_______
Maximum Proposed Height
Basement_____
Walkout Basement
Total Bedrooms_
Sq. Ft.
Setback to Lotline 3>0 Ft. &
Setback to Right of Wav^ 5 Ft.
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level
Setback to Septic Tank Ft.
Setback to Drainfield /O Ft.
So''Sq. Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield___
Setback to Bluff_______
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
**Project/Lotllnes/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft."Ft.&Ft."Ft."Ft.&Ft."
Ft."Ft.____Ft..
/ 3 / Ft.Ft.Ft.
Ft.Ft.
Ft.Ft.
Ft.Ft.Ft.Setback to Bluff
Maximum Proposed Height _
Bathroom Proposed ( ) Yes
Ft.Ft./ V Ft.Yes No
Ft.Yes No No
( ) Screen Porch
( ) Storage Structure
1' Must include on scale drawing
Permit may be required
Topographical Alteration / Earthmovina
□ None ,□ 20 Cubic Yards or Less ' □ 21 Cubic Yards - 299 Cubic Yards'
CHARACTERISTICS OF LOT:
1□ 300 Cubic Yards or More*
Bluff .Yes No.Ft.Water Frontage.Sq. Ft.Lot Area.
.%X100 =Impervious Surface Ratio:Impervious Surface RatioTotal Lot Area (FT^)Total Impervious Surface Onsite (FT»)
TH/S IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Offer Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County,
Minnesota. This permit may be revoked at any time upon violation of said Ordinances.
I understand that it is my respo^ibility to inform the Land & Resource Management office once the building footings have been constructed.
C __ -/ ,/ ' ' ' t -3
Signature opppcp^fty pwne
\Date;y
V<7-Date:
Land S ngadurce Management
576 RECEIPT NO.PERMIT FEE $PROJECT(S) TOTAL SQ. FT.,
Comments:
313,012 • Victor Lundeen Co.. Printers • Fergus Falls, MinnesotaForm No. BK — 0203-0501
Ir
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
Structure Set Back from Ordinary High Water Level .V Ft., Ft.*^/3/
Structure Set Back from Top of Bluff Ft.
Structure Set Back from Road Right of Way 5"' Analh Ft.
to ^toStructure Set Back from Lot Lines Ft.&Ft.Ft.Ft.&
Structure Height Ft.Ft.
Structure Set Back from Septic Tank Ft. Ft.4- ■^0
Structure Set Back from Drainfield -r Ft. Ft.
Elevation Of Lowest Floor Above Ordinary
High Water Level 4- I Ft. Ft.
Land Slope at Building Site %%
Inspector’s Comments / Sketch:
i::
1
J
Inspector's Signature
Date of Inspection
r-zi
Time of Inspection
laf ylol^Project Approved
Date / Initial
+GRADE & FILL APPLICATION
COUNTY OF OTTER TAIL - LAND & RESOURCE MANAGEMENT
121 W JUNIUS SUITE 130, FERGUS FALLS, MN 56537 T - “218-739-2271 4-
PERMIT NO.$50.00Application Fee
Receipt Number I
DAYTIME TELEPHONE
PROPERTY OWNER L L
MAILING ADDRESS 3-
r-^i.rnIff{
CITY, STATE, ZIP J^<^nl
rA)^ LAKE NO. _________________________________________ _____
J^OQd/EONVCG/ ^ <^><50PARCEL NUMBER (S) dt661 dd^ 9sCC0 iH(£60Y06{p^OO! JHdCdi'? A)/^/OtF3
CLASSLAKE NAME
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/i^JOV/7 HORANGE TWP NAMESECTION TWP
±LEGAL DESCRIPTION
^ }
H-E-911 PROPERTY ADDRESS/FIR^ NUMBER {
6//^JoD
DATEPROPERTY OWNEISIGNA'[ENT FOR OWNER
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Received
DATEL&R Official +-1
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DESCRIBE PROJECT REQUEST BELOW (Provide Scale Drawing On Back)T it .4---
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f iDatedSignature
Please use this sheet for the required scale drawing of your proposal. Be sure to include lot dimension, water
frontage, and setbacks from RW, lake, sideyard, sewage system, top of bluff and existing structures. ^ r V
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299.948 • Victor Lunoeen Co. Printers • Fergus Falls. MN • 1-800-346-4870 •X
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Grade & Fill Permit #2573
PROPERTY OWNER ^\\\- >cn \ <X_______
VoXck, _LAKE NQ?^^B^SEC.TWP. NAME
o C-.Qs\\o rOV\x S \-
LEGAL DESCRIPTION:
WORK AUTHOkiZED C^Xcan)Sk Vo Y^b O
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NOTE: This card shall fie placed in a conspicuous place not more than 4 feet above grade on the premises on which
work is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MAN
AGEMENT. 218-739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED.
cx s vSC.^’XS 9~
^'\S^ . T>Ov>SAC-« <—C<>rfVr«<c^^»»
1. EARTHMOVING SHALL BE DONE BETWEEN L,-\g-QO &
2. Entire area shall be stabilized within 10 days of completion of any earthmoving.
3. Owner is legally responsible for ail surface water drainage that may occur.
4. No fill shall enter or be taken from the beds of public water without a valid permit from the
MN Department of Natural Resources.
5. If the terms of this permit are violated, the entire permit may be rayoked and the owner may
be subject to legal prosecution.
■' -4‘;
Lan^Fft^Kesourceraanagement Official
I,
tiK.n9nnQfi.nn‘a
LICENSE APPLICATION FOR
FOOD, BEVERAGE OR
LODGING ESTABLISHMENT
OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH
Division oE Environmental Health
Courthouse
Fergus Falls, Minnesota
218/739-2271
56537
P Print, type or check all applicable boxes, in-
I complete and illegible applications will not be ac-
I cepted and penalties may be assessed.
Old EstablishmentApplication Type:JAh! iNew EstablishmentNew LicenseeHeneual i 2 1987
License#Name of previous owner:
Social SecurityR>! L 70/C7/aA//cAApplicant Name:
If Corporation, name of officers:
I Minnesota Business ID #:A?-/) o/i/ />?E 5 L a b 1 i s r, ,Ti c i 'i t n a i7i e ;
Establishment location: /Uo/t7~A
ClcQA^Ty
3sLake/Stream /9-S)ad^ City/Iownship
dOe rJ //27 / /t/ /t/.Establishment Nailing Address:---
Temporary StandCombinationRegular:
fiestauranr # of seats
lAResort
____Limited Fc:d/Iemporary Food Stand
# of units
Place of Fefreshment/Beverage Service # of seats
Hotel/Notel # of rooms
Boarding/Lodging House # of rooms
Total number of employees
(See Oefinition)
Does establishment provide Caterimg?Carryout?
Business hours Year around Seasonal Opening Date;
Closing Date: c3->
VWater supply source:Municipal Private
PrivateSweage system:Municipal
Outdoor pool ''y<^ Boat landingOther facilities if provided:Beach ____Indoor pool
CampingStore
\
Winter number if different 3 3 - C><3 ^73Telephone number /<^)- f ef
(..Department of iLAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY [
Government Services Center - 540 West Fir
Fergus Falls, MN 56537
PH: 218-998-8095
Otter Tail County’s Website; www.co.otter-tail.mn.us
1
i,
September 30, 2013
Collene Barnick
720 38^^ St NW
Fargo, ND 58102
1
1
RE; Boat Ramp, Pocahontas Resort, Dead Lake (56-383)
Dear Ms. Barnick:
This letter will confirm our September 25, 2013 onsite meeting during which we discussed
your request to replace your existing boat ramp.;
IAs we discussed, you may replace your existing 12’ x 3T concrete slab with a new
concrete slab of the same size and in the same location. As we also discussed, since
there will be little, if any, earthmoving required and since there will be rio change in
existing impervious surface, you.may proceed with this replacernent without a Grade/Fill
Permit from this Office. Please be sure to notify our Office once the replacement slab has.
been installed.
■ ^
■
If you have any further questions regarding this matter, please contact me (21.8-998-
8095)..■1
Sincerely,
BilIKalar
Administrator i
. I
i
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APPLICATION FOR GRADE & FILL PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
LAKE/RIVER #LAKE/RIVER NAME LAKE/RIVER
CLASS,
SECTION TWP. NO.RANGE TWP NAME
o//7 /? Cf\yb
PARCEL NUMBER(S) PROPERTY (E-911) ADDRESSOOq^OOO I'^oooilOnilooo ^ttJO
i^Oocty>S<X>C;-^oo\ Cchjl <^n( HLaM S <T
LEGAL DESCRIPTION
?r<9)L\ i X
Last Name First Initial Mailing Address DAYTIME Phone No.
Ccj/ler^3^0^ 7 rt/ Aff, y
'L ‘f~~ /K A J 5 _________
Property
Owner
JoijContractor
Name ?cv-m-i9mSf.lF
wLie.#
NOTES: 1. The lotlines and project area(s) must be staked.
2. If project disturbs more than 1 acre of land you are required to obtain a General
Storm Water Permit from the MPCA.
hiL
y&R Official
Received
DATE
PROJECT REQUEST (You may use the grid on back for required scale drawing):
—Sa n<y—-U^—kiS.DESCRIBE YOUR PROJECT(S):
ug
/ y /It
■y y
II %\\ \)i Lk |.1T hi
^ ~^( -O U 4~k«^-v WXll
W’lrljL, -b p/c.
Q C t V-fe
DETAILED INFORMATION:
AREA TO BE CUT/EXCAVATED:Yds"Ft. X Ft. X Ft. - 27 =
Length Width Ave. Depth
Yds"WALK-OUT BASEMENT PROJECTS:
(Outside of the building foundation)
Ft. X Ft. X Ft. - 27 =
Length Width Ave. Depth
200 k6 Ft. - 27= >7Oh Yds"AREA TO BE FILLED/LEVELED:Ft. X Ft. X
Length Width Ave. Depth
Yds"TOTAL EARTHMOVING REQUESTED =
BACKFILL AT FOUNDATION:Ft. Ft.
Distance From FoundationMax. Depth
CULVERT:If Yes, must indicate size and location on drawing.
Yes No
IMPERVIOUS SURFACE:%
/J TsIGNATCTRE OF PROPERTY dVWEfcAGENT FOR OWNER,^.^ / DATE
/3K02/09 B
RECEIPT NUMBER
;
SOUTHERL r LINE
OF OLD S.A.R. NO. 12
PEP SU8L0T PLAT
( DEED - 20r )
S 45'06' 15" W 203.00)«r.50
J67.5' )
o ja-os'**""'
s j6%L2i 164.^" W
I
D£tD 17"''00'iio 17V QO'00-
)wD ANGLE
PROP ONE
ijEto Ancleand distanceu ANOPROP. LINE PEP Distance0I,\oi
7j \\;>\/V /
SUBLOr pia\f~* — ~-- - V— — il._____7J /-7/7J e"i>
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7J i&I - ^/-7
/fI V, ^}I /VI3ti^ .1I^ "^f^AtLER ‘'1-I /CAMP SITES!tIt7‘%iiI
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//fOLlui^S tNPLACe r£NCE ------fisrr pf^op
-----!i
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VCABINSCabinsCAMP SITES CABINS
*1.3
PFr< SUSLOT PLAT-.
-----r>-----
■s^ neifl 'arafoo’{ OE£D - 31*.E )
'it
White — Office
Yellow — Owner
Pink — Assessor ,
Goldenrod — Inspector
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone: (218) 739-2271 - Fergus Falls, Minnesota 56537
APPLICATION FOR SITE PERMIT
Permit No..LEGAL
?'occ\l\ o»t<iS f{eser-^
St-3 Si /g !35~ V-O
DESCRIPTION
AND
LOCATION
TWP NameSec.TWP RangeLake Classif.Lake NameLake No.
IDENTIFICATION: Please Print All Information
Tel. No.First Zip No.Mailing Address— No. Street. City and State
i3oi^b oi^keaji ^
InitialLast Name
2! fOwner
^3r5-mo1
NameContractor
Architect Name.
NON-RESIDENTIAL PROPOSED USE;RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT:
New Building
( ) Alteration
Specify:.( ) One Family Dwelling
( ) Muitipie Dwelling
(j^Other
Units
I7-X510' EA!( ) Other Size
ESTIMATED COST OF IMPROVEMENT $
DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME:
>Xf No IMasonry
( ) Wood Frame
( ) Structural Steel
(. ) Other — Specify
Basement: ( ) Yes
Stories above basement:
Sq. feet (outside dimension)
Bedroorhs .....
( ) Public
Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
Individual Well
Baths
Af
CHARACTERISTICS: ,LotAreais;?..'/.^.^.^^
Building set back from high water mark is
£0£.,feet.Maximum depth of lot feet.square feet.Water frontage is ..
feet. (Building Line)
feetLand height above high water mark at building line is
Building set back from State highway right of wa,y....
Side yard is
Structure will be located
o'^.^.Ol feet.feet — from road right of way is■+iQl m ............feet.
feet from septic tank (Sewage System Permit must be obtained before installation).
feet from soil absorption system (Sewage System Permit must be obtained before installation).
and
M.
xsl.Structure will be located
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
rw/s IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand
I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project.
Jk’Signature of Owner
i-lx - /f/7Dated.
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
^-/x~/9F7 4-Dated
Shoreland Management Officiali2P^0 t COPermit Fee $.Receipt No.
In ^ "T O SiJ
Comments;
Form No. MKL-0286-019 229971@
VICTOR LUNOEEN CO.. PRINTERS, FERGUS FALLS. MINN.
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Yellow — Owner
Pink — Assessor j>
Goldenrod — Inspector
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone; (218) 739 -2271 — Fergus Falls, Minnesota 56537
APPLICATION FOR SITE PERMIT
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r /-j- 4Permit No>LEGAL
//:DESCRIPTION
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LOCATION
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I': 'TWP NemeTWPRengeSec.Leke Clesslf.Lake NameLake No.
IDENTIFICATION: Please Print All Information
Tel. No.Zip No.Mailing Address— No. Street. City and StateFirstInitialLast Name
, /Owner
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NameContractor
Architect Name.
NON-RESIOENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:
( ) One Family Dwelling
( ) Multiple Dwelling
( ) Other
TYPE OF IMPROVEMENT:
Specify:.(\ ) New Building
( ) Alteration
( ) Other
Units
V'■ , >•/Size
ESTIMATED COST OF IMPROVEMENT $
DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME:
( )Yes ('•> No j( ) Public
(' ) I ndividual Septic Tank, etc.
WATER SUPPLY:
I ) Public
( v ) Individual Well
Basement:
Stories above basement:
Sq. feet (outside dimension)
Bedrooms ..............................
( ) Masonry
( ) Wood Frame
( ) Structural Steel
( ) Other — Specify
"Trr
XBaths
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Maximum depth of lot
CHARACTERISTICS:
' oI7 feet.feet.square feet. Water frontage is
Building set back from high water mark is....................
Land height above high water mark at building line is
Building set back from State highway right of way.....
Side yard is .....................
Structure will be located
Lot Area is
feet. (Building Line)
feet
/.feet.feet — from road right of way is
• r.............feet.
.feet from septic tank (Sewage System Permit must be obtained before installation).
feet from soil absorption system (Sewage System Permit must be obtained before installation).
and f
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Structure will be located
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
THIS IS A SITE PERMIT ONL Y AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STA TE STA TUTES.
I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand
I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project.
Dated,
Signature of Owner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
//4fDated
Shoreland Management Officialf ■
Permit Fee $.Receipt No.t
f/tc ••/;V JComments:/, / 4 /
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orm No. MKL-0286-019 229971@ VICTOR LUNDEEN CO.. PRINTERS. FERGUS FALLS. MINN.
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INSPECTOR'S CHECK LIST
Make all measurements and computations
ACTUAL
IS jr MINIMUM Shall Be Sq. Ft
Lot Area (Square feet)Sq. Ft Sq. Ft.
Water Frontage Ft. Ft.ojl
Building Set Back from High Water Mark Ft.Ft.
Building Set Back from State Highway Ft.50 Ft.
Building Set Back from Street or Road Ft.40 Ft.
rh & / ^ ^ Ft.OSide Yard &Ft.
oKRear Yard Ft.Ft.
-h^0Occupied Building to Septic Tank Ft.10 Ft.
Occupied Building to Absorption System Ft. 20 Ft.
Elevation at Building Line above
High Water Mark_____________7^Ft.3 Ft.
1 s'u ff vJ '4 /• VInspector's Comments:
Inspector's Signature
Title
Inspection
Dated 7'/~n19
/Agency
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