HomeMy WebLinkAboutRogers_13000320206002_Shoreland Permits_r-
WHITE - Office APPLICATION FOR SITE PERMIT
GOLDENROD - Inspector
YELLOW - Owner (after issue)
PINK - Assessor
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
PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP NO.RANGE TWP NAME
ST-Tri ^2.R-O
PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS
I ^ 2> ao 3 o ”2^3
LEGAL DESCRIPTION
GC /
Last Name First Initial Mailing Address Daytime Phone No.
[q-iSHProperty
Owner qs.y^ try
\
Contractor
Name
Lie. #
ONSITE SEWAGE { (^popngpn project (please circle the appropriate number)
(1 ) New^elllng ( 2 ) Add’n to Dwelling
( 5 ) RCUA'ear_____
( 7 ) Add’n To Non-Dwelling ( 8 ) Storage Structure
(10) Other.
ONSITE WATER SUPPLY
^ Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
TREATMENT SY( 3 ) 'Replacement Dwelling
( 6 ) Detached Garage
(9) W.O.A.S.
( ) Permit No.
( ) OTLSD * This permit is only vaiid after verification
from the O.T.LS.D. that a conforming sew
age sysfem wiii be instatted to service this
lot contact Rottie Mann at 864-5533.
(4 ) MHA'R.
'Existing Dwelling to be removed before.
CHARACTERISTICS OF PROPOSED W.O.A^.
(WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED DWELLING
Ft.x > y
CHARACTERISTIC
Outside
Dimension
TS OF PROPOSED INDWELLING
3cr' 7 2-Outside
Dimension t OutsideX
DimensiofFt,"
So. Ft. 3H'-in
Setback to Lotline SG
Setback to Right of Way Ft."
Setback to Ordinary High Water Level lO O ' Ft,
Elevation Above Ordinary High Water Level 3
Setback to Septic Tank lO Ft.
Setback to Drainfield ^ Ft.
Ft. X Ft."
Sq. Ft.
Setback to Lotline Ft. &
Setback to Right of Way Ft."
Setback to Ordinary High Water Level 1^0 Ft.
Elevation Above Ordinary High Water Level 3
Setback to Septic Tank pt.
Setback to Drainfield Ft.
|Oj/A Ft
Maximum Proposed Height___
Roof Change ( ) Yes (^) No
Bathroom Proposed ( ) Yes ( No
(Sq. Ft, \
Setback to Lotline
Setback to Right of Waj
Setback to Ordinary High Wl^r Leve^__
Elevation Above Ordinary High W^r Level
Setback to Septic Tank
Setback to Drainfield
Setback to Bluff___
Ft,"Ft."Ft.&Ft."
I Ft.:I
Ft.Ft.
Ft.Ft.
Setback to Bluff
Total Bedrooms
Maximum Proposed Height SS~ Ft.
Roof Change ( )Yes ()^)No
Basement ( ) Yes (^) No
Walkout Basement ( ) Yes ( ^ No
Ft.I Setback to Bluff Ft.^:S^Ft
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
Ft.
( ) Screen Porch
( ) Storage Structure
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
y^21 Cubic Yards ■ 299 Cubic Yards*
Topographical Alteration / Earthmovina
□ None
* Must include on scale drawing
Permit may be required□ 20 Cubic Yards or Less *□ 300 Cubic Yards or More*
CHARACTERISTICS OF LOT:
( ) Yes I^^NoSq. Ft.Lot Area,Water Frontage .Ft.BluffTVTt
Total ImpervioiK Surface Onsite (FT!)
IImpervious Surface Ratio:X100 =.%Total Lot Area (FT)Impervious Surface Ratio
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 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 con-
I conform in all respects to the Ordinances of Otter Tail County, Minnesota.dition that the person to whom it is granted, and his agent, employees and wor
This permit may be revoked at any time upon violation of said Ordinances!'^
I understand that it is my responsibiiity to inform the Lam lanageiperft office once the building footings have been constructed.lesi
/7_C7(^
Date:
of Pa frty Ownerjnature
5'—Date;
Land S Resource Man^erne^i^^a,^CTLol IHo2Q)CPROJECT(S) TOTAL SQ. FT..PERMIT FEE $RECEIPT NO.
1—2^ 4,;C\t\ A. ^ S»J\V,\ \q ^<7-20Comments:
Form No. BK — 1003-0505 322,179 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota
' - Office APPLICATION FOR SITE PERMIT
lOD -^p^tor
- Owner (after issue)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
... - Assessifr
PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP NO.RANGE TWP NAME
J—3^ r-c.■TC 7Vf W2 r s.
PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS
V V N-J '( 4 .(3, <3 0 3 ”Z-<D2-3
7cTTTt7LEGAL DESCRIPTION
i e ?(f
Last Name First Initial Mailing Address Daytime Phone No.
VO F l o 1 2333[03>Property
Owner a-*r <;
ixlV -Vxi v-' ^
Se,L.FContractor
Name
Lie.#
KTPROPOSED PROJECT (please circle the appropriate number)
{1) Nw Jewelling'' ) (2 ) Add’n to Dwelling
(4) MHA'R
( 7) Add’n To Non-Dwelling {8 ) Storage Structure
(10) Other.
ONSITE WATER SUPPLY
^ ) Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
ONSITE SEWAGE TREATMENT SYSTEM (i ^ | T --0*-
(3) 'Replacement Dwelling
( 6) Detached Garage
(9) W.O.A.S.
( ) Permit No.
( ) OTLSD * This permit is only valid after verification
from the 0. T.L.S.D. that a conforming sew
age system will be inslatted lo service this
lot contact Rollie Mann at 864-5533.
(5) RCU/Year.
'Existing Dwelling to be removed before.
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension..
CHARACTERISTiqS OF PROPOSED NaH-DWELLING
Outside
Dimension
CHARACTERISTICS OF PROPOSED DWELLING
Outside
Dimension ___
Sq. Ft.
Setback to Lotllne
2>0 7IFt. X ^ S' Ft."
TeT
rFf.&_i±l_
'J'f Ft. X Ft."
Ft. X Ft."
Sq. Ft.
Setback to Lotllne
Setback to Right of Way
Setback to Ordinary High Water Level ______
Elevation Above Ordinary High Water Level 3
Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff F’ / ^ Ft.
Maximum Proposed Height___
Roof Change ( ) Yes () No
Bathroom Proposed ( )Yes ( ;<) No
Sq. Ft.
Setback to Lotline \
Setback to Right of Way V
Setback to Ordinary High Wate^^eve
Elevation Above Ordinary High W^r Level
Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff
'V'OFt."Ft.&Ft."\Ft.&Ft."Setback to Right of Way
Setback to Ordinary High Water Level
Ft."'vFt."lOO IFt.loo Ft.3Elevation Above Ordinary High Water Level
Setback to Septic Tank I ^ . Ft.
Setback to Drainfield
Ft.Ft.
Ft.Ft.■‘ar^ Ft.L\Ft.
/a2^ aSetback to Bluff
Total Bedrooms
Maximum Proposed Height
Roof Change ( ) Yes ( 7) No
Basement ( ) Yes C%) No
Walkout Basement ( ) Yes ( 7^ No
/fl37 Ft.Ft.Maximum Proposed H^ht
( ) Boathouse ' <
( ) Gazebo
**Project/Lotllnes/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
( ) Screen Porch
( ) Storage Structure
','0Topographical Alteration / Earthmovina
□ None
' Must include on scale drawing
Permit may be required□ 20 Cubic Yards or Less 'ja 21 Cubic Yards - 299 Cubic Yards'□ 300 Cubic Yards or More'
CHARACTERISTICS OF LOT:L O-h br
Bluff ( )Yes 7S.NoSq, Ft.Lot Area,Water Frontage .Ft.nr
^ o
j it . lie
r c.J.Impervious Surface Ratio:Xioo =.%Total Impervious Surface Onsite (FT^)Total Lot Area (FT')Impervious Surface Ratio
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 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.
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 con
dition 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 responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed.
- / 7 , o (v'.Date:
Signature of Property Owner.
■'......7 /
Date:
Land & Resource Maoai^ment OtBee
PERMIT FEE $ ~ ________CCoT HOIIPROJECT(S) TOTAL SQ. FT.,RECEIPT NO.
L . t'VI,3 V o r.-<—(3 (o-^oc>. ■< ov*;,L,.C- fComments:
Form No. BK — 1003-0505 322,179 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota
f
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
no"Structure Set Back from Ordinary High Water Level I Ft.Ft.toi
Structure Set Back from Top of Bluff Ft.Ft.
^OO^ocfStructure Set Back from Road Right of Way Ft.Ft.I'-i o a '“S'oc?
Ft. & tan^Ft. &(Structure Set Back from Lot Lines Ft.Ft.
lO I ustructure Height Ft. Ft.
Structure Set Back from Septic Tank Ft.Ft.
r\4Structure Set Back from Drainfield Ft.Ft.
Elevation Of Lowest Floor Above Ordinary
High Water Level 7-/0'Ft.Ft.3-V
Land Slope at Building Site % %
Inspector’s Comments/Sketch:
ho'>
X
V
LkInspector’s Signature
H.
Date of Inspection
c
Time of Inspection
yProject Approved
Date / Initial
Grade & Fill Permit 3i.4e
PROPERTY OWNER
LAKE N0.^-7V( sec.
LEGAL DESCRIPTION:
y"5
r«»*V y'ouTWP. NAME_
Ll^ ^ I Zj0 Z.*\
WORK AUTHORIZED A r\y cwwx
I ^ . pi S yv^«».U
A VVcXs . ^irv\Ct^\
4“0rovv^ c^u. cAjc Svc-f ^Ca.v4t*
^''4-0 ItJ*
O r\
cov/Vv.O VN
O A v*vv iw ‘vAr^^ £)N^\-V»-Vs Ark rv\ ^ ?Vv.o^
Yoto>«i \~ojp , AU
row
%
NOTE: This card shall be placed in a conspicuous place hot more than 4 feet above grade dn the premises on which
work is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MAN-
igEMENT^2^^2^1 WHE^^H(^!|ED^^^1^HAS: BEp^COMP^LETED^^^^^^.^
1. EARTHMOVING SHALL BE DONE BETWEEN 4-V-c.z, & ?-<-<> Z,
2. Entire area shall be stabilized within 10 days of completion of any earthmoving.
3. Owner is legally responsible for all surface water drainage that may occur.
4. No fill shall enter or be ta^en 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 revoked and the owner may
be subject to legal prosecution.
C-owsr^' ' V
V V
I
■:n
’
T GRADE & FILL APPLICATION1-rt !‘ r:i-|'a--i-
. -!i
-COUNTY 0F:OTTERilWII^LAND:«rRESOUReE MANAGEMENT^
[ W^UNlUi^UITE 1^, FERGUSEALL^
_____ lJ. . . ■ - ' ' . • • ,
rrd"-M-
• V--218-739-M7;1 -
ApplicationFee: $50;06
!-
i
; — rprRERMITNO,I;;
1
t' -PjRGPERTY OWNER y ^ 9 Irti::-!.:!i
jMAILING ADDRESS i 7S CTUrUyyn y ^ f c/ 0 ^
cTtv,;stAte7 zip~~^A^Tr) kj
DAYTIM^PHONE NUMBER
LAKE NAME S
i
!
J:v\ iSj .J: J_ .::_L_1r:!J-;\t i
r: TIlAKE NO. /class nIrtt:;:
_j_r„^~fARgel^umber(S)[ 7:^'Q^aQ?S^^ XC5\ no'3:
gECTlON- ^9
I llegal DESCRIPTION /o r, /
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=!i:r
eL.!:TWP NAMEi3WiaLg i~/1/\ULajlJC!
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_ IiJJI;■^1::[•ZE-911 PROPERTY ADDRESS I i I .' 11 I t
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-■--I VcLLL .1-1 SIGNAfu|RElbR-RROp’E^ bWNER/AGENt|l=€iR OWNER ! ^DATE/II
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Fergus Falls,'mN •^1-800^346-4870 . L.^.
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BK05/00J ] 1 ; 1F ' ' ' ' 305,910 • Victor Lundeen Co!, Printers • Fe' ’ ' ^X
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feetinch(es) equalsfeet, or.grid(s) equalsScale:
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, lot lines, sewage system, top of bluff, existing structures and all imper
vious surface.
Required impervious surface coverage calculation (See definition in Shoreland Management Ordinance)
%X 100 =
Total Lot Area
(FT2)
Total Impervious
Surface Onsite
(FT2)
*
a
//
DatedSignature
BK —0500 —029