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Home My WebLink AboutRose Shores Campground_32000080057001_Shoreland Permits_WHITE - Office GOLDENROD - inspector ' APPLICATION FOR SITE 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 YELLOW - Owner (after issue) PINK - Assessor Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. RANGE ™p nameTWP NO.LAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE / RIVER NO. hhkrt£mRD PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) 3>n - pan -^-k-c-iOS-l -oa>- se /r? LEGAL DESCRIPTION fT Sl^‘ e af- ui. Daytime Phone No.Mailing AddressFirstInitialLast Name CjoMujyY RoiC’ ______S^.lue%---------------- Property Owner <-/SCS' 2lki23^LllAY Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) d^New Dwelling (4) MH/YR____(7) Add'n To Non-Dwelling (^Jstorage Structure (10) Non-Conf. Replacement (identify)"_______ (11) Other (identify)_____________________ (12) Deck___________________________ (13) Fence___________________________ ONSITE SEWAGE TREATMENT SYSTEM ( ) L&R Cert, of Compliance within 5 yrs. (_^ Compliance Inspection Report within 3 yrs. (Attached) 3 — ( ) OTWMD 'Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rome Mann at 218-864-5533 ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. (3) Replacement Dwelling* (6) Attached / Detached Garage (9) W.O.A.S. ( 2 ) Add'n to Dwelling (5 ) RCU/Year____ "Existing Non-Conf. Structure Verified by L&R‘Removal of Existing Dwelling Verified by L&R Inspector's Initial/Date/nspecfor'5 Initiai/Date CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROP Outside Dimension )F PR0P(^ NON Ft, x Ft." D NON-DWELUNGCHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) Ft.**Ft. XOutside Dimension Sq. Ft._______. Setback to Lotline ' Ft. X Ft.** Sq. Ft. Setback to Lotline Ft. & 3 Ft." Setback to Right of Way Ft." Setback to Ordinary High Water Level Ft. Elevation Above Ordinary High Water Level Setback to Septic Tank /6O Ft. Setback to Drainfield lOO pt. Setback to Bluff Sq.Ft._______ Setback to Lotline Setback to Right of Way_____\ W." Setback to Ordinary High Water LeyePy Elevation Above Ordinary High Water Lev^l Setback to Septic Tank__ Setback to Drainfield__^ Setback to Bluff_______ Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / inspection FI.&Ft.** Ft.**Ft.&F/*Setback to Right of Vlftw _______ Setback to Ordinary HigtrWater Lew Elevation Above Ordinary Hi^W^r Level Ft. Ft. Ft. Setback to Septic Tank__ Setback to Drainfield____ Setback to Bluff______. Total Bedrooms_____/ Maximum Proposed H^ht Roof Change ( ) Y« ( ) No Basement ( ) Yea ( ) No Walkout Basement ( ) Yes (side profile required) ( ) No Ft.Ft. Ft. Ft.Ft. Ft.Ft.Ft.^20 Ft.Maximum Proposed Height Roof Change ( ) Yes ()^ No Ft. ( ) Screen Porch ( ) Storage StructureBathroom Proposed ( )Yes (^No QA'f Cubic Yards - 999 Cubic Yards* * Must include on scale drawing, additional Permit may be required. Topoaraphic^Alteration / Earthmovina 20 Cubic Yards or Less *□ 1,000 Cubic Yards or More*□ None /acoCHARACTERISTICS OF LOT: Lot Area /<0 ( ) Yes (^ NoFt.BluffS^.Water Frontage M..%.% Impervious Surface RatioBuilding 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 responsibility to inform the La Date: ___________^ ource Management office once the building^otings have been constructed. Property Owner / Agent for OwnerSignatm Land & Resour^ Management Official permit FEES ^00 IDDate: RECEIPT NO.PROJECT(S) TOTAL SQ. FT. Date StampComments: received uU 0 9 2015 land & RE«OURCE L&R Initial Form No. BK — 08-015-2013 352,196 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota )N FOIUITE PERRWHITE-Office, , GOLDEmoD - m^em^ YELLOW - Owner (after issue) PINK - Assessor APPLICATION FO r LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLEN 56537 218-998-8095 tO www.co.otter-tail.mn.us Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. TWP NAMELAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO RANGE PARCEL NUMBER (S) £RD ir \PROPERTY (E-911) ADDRESS of- C'i , 3.1 - Pan -adx-_______ lega™™n ^ $~/y Sl^'e af CO- -56 i /f Daytime Phone No.Last Name First initial Mailing Address 3^ (^^90 Co MuJ V ^ <;gs~vy Property Owner PLCln^ie ^ . j \miHlP j2o'jr A iContractor Name Lie.# I i ! PROPOSED PROJECT (please circle the appropriate number) DwsllinQ tT) mha'r__ (7 ) Add’n To Non-Dwelling f^^Storage Structure (10) Non-Conf. Replacement (identity)''_________ (11) Other (identify)________________________ (12) Deck________________________________ (13) Fence______- ____________________ 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 ( ) L&R Cert, of Compliance within 5 yrs. ( 3) Replacement Dwelling* (6) Attached / Detached Garage (9) W.O.A.S. ( 2 ) Add’n to Dwelling ( 5) RCU/Year_____ (,^ Compliance Inspection Report within 3 yrs. (Attached) ■ ■ _, ( ) OTWMD 'Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rollie Mann at 218-864-5533t r I •'Existing Non-Conf. Structure Verified by L&R‘Removal of Existing Dweiiing Verified by L&Rr Inspector's fnitiat/DateInspector's Initial/Date CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERI§;nCS OF PR0P0,SED NON-DWELLING ^Ft.x So. Ft. Setback to Lotline Setback to Right of Way Ft.** Setback to Ordinary High Water Level ^ Ft. Elevation Above Ordinary High Water Level Ft. Setback to Septic Tank ! HCj Ft. lO^ Ft. CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) Outside Dimension___ Sq.Ft.^ Setback to Lotline ^__ Setback to Right of Way Setback to Ordinary High'^vyater Leve Elevation Above Ordina Setback to Septic Tank Setback to Drainfield _ Setback to Biuff_____ Total Bedrooms_____ Maximum Proposed He^ht_____ Roof Change ( ) ( ) No Basement ( ) Yes/ ( ) No Walkout Basement ( ) Yes (side profile required) ( ) No Outside Dimensii Ft.**Ft.**Ft. x Ft.** /Ft. X Sq. Ft. Setback to Lotline Ft. & 3 Ft.**Ft.**Ft.& j:^Ft.&Ft.**F/* Setback to Right of Way Setback to Ordinary High Water Ley^\ Elevation •<Ft. ry Hi^W^r Level Ft.Ft.i \Ft.Above Ordinary High Water LeV^ Setback to Septic Tank Ft. Setback to Drainfield___^ Setback to Bluff Maximum Proposed Height _ ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / inspection Ft.i.) Ft.Setback to Drainfield Setback to Bluff___ Maximum Proposed Height J20 Ft. Roof Change ( ) Yes ( No Bathroom Proposed ( ) Yes ( ^No iFt.3Ft.IFt.r Ft.■ Ft. ( ) Screen Porch ( ) Storage Structure 1 Topographical Alteration / Earthmovina □ None 20 Cubic Yards or Less * i;^2i''Cubic Yards - 999 Cubic Y^ds* CHARACTERISTICS OF LOT: Lot Area 3q-Et. * Must include on scale drawing, additional Permit may be required.□ 1,000 Cubic Yards or More*! Bluff ( )Yes ()().NoWater Frontage Ft.■'I i12^.%].% Impervious Surface RatioBuilding Surface Ratio TH/S /S A SHE 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 hereiti4s 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 Tall County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances.I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. -------- ^------------------------------------------------------ SignatuT&'-Pi Property Owner / Agent for Owner I ; Date: iiTvlrjiiirDate;______________________________LJ Land & Resoufeh Management Official jw®“1“ IPROJECT(S) TOTAL SQ.FT.PERMIT FEE $RECEIPT NO. id'Comments: SCANNEDt Form No. BK — 08-015-2013 352,196 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Ho' X S'fe sV)d structure Set Back from Ordinary High Water Level Ft.Ft. Structure Set Back from Top of Bluff Ft.Ft. )oS^Structure Set Back from Road Right of Way Ft.Ft. Ft.&_J^foot*Structure Set Back from Lot Lines Ft.Ft.&Ft. <30*Structure Height Ft.Ft. lo*-Structure Set Back from Septic Tank Ft.Ft. structure Set Back from Drainfield Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level Ft.m. Land Slope at Building Site %% Inspector’s Comments / Sketch: it4 1^C X : :; .r Inspector’s Signature Date of Inspection Time of Inspection s?roject Approved. Date / Initial 4 i Rose Shores Campground 34890 County Highway 4 Frazee, MN 56544 218-334-4565 RECEIVED APR 1 1 2016 Dear Denise,land & RESOURCE We would like to amend our Site Permit #28484 to include a total size of 56' x 30'. I have attached a new drawing to show this. We are planning to add 13' to both sides of this building, they will be enclosed. Also, as you and I talked about, I would like to get the Site Permit extended as our builders are booked into June. This project will be completed by mid-summer. Please contact me if you have questions, or if we need further documents. Thank you Jimmie and DeAnn Anderson 218-234-9124 iimmie@roseshores.com SURVEYORS DRAWING ?SE LAKE CAMPGROUND IN SECTION 8-137-40 R TAIL COUNTY, MINNESOTA \ i 1 □l4oc/Se 5V^f i 14 lURVEYORS DRAWING SE LAKE CAMPGROUND N SECTION 8-i37-^0 ? TAIL county. MINNESOTA ! ; ;.; • •, : . • . ■ V.. • y \:/ ■ ‘f •• ,c •. ,■ ■ \ r . :1 r :: ; \ D ; ■k 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.inn.us Permit No.PLEASE PRINT OR TYPE ALL INFORMATION LAKE/RIVER #LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP. NO.RANGE TWPNAME Vq fhLori-Rxp Oaicg~ 3^0 TI^D PARCEL NUMBER(S)PROPERTY (E-911) ADDRESS /joy ¥ P/tH7J3f SCsyc/ (i/oj 5/r'e-fto LEGAL /r? Last Name First Initial Mailing Address DAYTIME Phone No. o a. V £jLAnJ£i ,JiY*ynuS’ CJS€ (2o<;f» KhmES' itoui^ri -------------------- Property Owner Contractor Name Lie.# Date Stamp RECEIVED * 0 9 2015 LAND & RE801JRCE 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. L&R Initial PROJECT REQUEST (You may use the grid on back for required scale drawing): DESCRIBE YOUR PROJECT(S): Ck- ?ia*tP/AJC _____>P<iL<s fTryru crun^^^m4cM6D ^u>T rr\t^ 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 ■yef' Ft. X Length Width Ave. Depth Ft.x_ld^Ft. ^ 27=^a» Yds' Ave. Depth AREA TO BE FILLED/LEVELED: Width TOTAL EARTHMOVING REQUESTED = Yds' BACKFILL AT FOUNDATION:Ft.Ft. Max. Depth Distance From Foundation CULVERT:If Yes, must indicate size and location on drawing. Yes SCANNEDndf o/o7.5" %IMPERVIOUS SURFACE:Existing Proposed Scale Drawing along with detailed impervious surface calculation must accompany this Application. / SIGNATURE^PROPERTY OWNER/AGENT FOR OWNER DATE RECEIPT NUMBER BK082013 WHITE - Office APPLICATION FOR SITE PERMIT GOLDENROD - Inspector 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 YELLOW - Owner (after issue) PINK - Assessor Permit No.PLEASE PRINT OR TYPE ALL INFORMATION TWP NAMELAKE/RIVER CLASS SECTION TWP NO.RANGELAKE/RIVER NAMELAKE / RIVER NO. I37RT> PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)Co scs'^yy3^ - ooo -OS'-oos'7 -oa 3_ •A y o F F<- • ^7 <3 M LQ LjfJG S(S-/SS LEGAL DESCRIPTION , ^ ^p-f S^y C- SLy fZ/uu S!S'£ e>F Daytime Phone No.Initial Mailing AddressLast Name First J=^jfh'ZJT£r ^ 6(oS^<^ Property Owner Ve~/I-F/^ sLyh/!/£‘_________ mContractor Name Lie.# ONSITE SEWAGE A [AS TREAPMENT SYSTElOlthermit No. ^ \ PROPOSED PROJECT (please circle the appropriate number) (2) Add’n to Dwelling (5) RCU/Year______ (8 ) Storage Structure ONSITE WATER SUPPLY yj Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. (3) ‘Replacement Dwelling (6) Attached / Detached Garage (9) W.O.A.S. (1 ) New Dwelling ( 4 ) MH/YR Add’n To Non-Dwelling (10) Non-Conf. Replacement (identify) _ (11) Other (identify)______________ ‘Existing Dwelling to be removed prior to. ( ( ) OTWMD ‘Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Confacf Rollie Mann at 218-864-5533 CHARACTERISTICS OF PROPOSED W.O.A.Sy Hi(ATER ORIENTED ACCESSORY STRUCTU^)CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING (mift Include Attached Garage) y Outsid^ DimensioiFt. X /dC? Ft."Ft. X I"Outsid»Dimension___ Sq. Ft. \ Setback to LofflHe ___ Setback to Right ohWay Setback to Ordinary Hi^Water Ley^ Elevation Above Ordinary High V^r Level Ft. X Ft." Sq. Ft. Z.f460 Setback to Lotline Setback to Right of Way Ft." Sq. Ft. \ Setback to Lolling Setback to Right of Setback to Ordinary HigtfWat^evel __ Elevation Above Ordinary Ri§\Water Level Setback to Septic Tanjy Setback to Drainfiera____ Setback to Blutf________ MaximumPfoposed Height ( ) Bpathouse ( gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ft.&Ft.&Ft." Ft."Ft.&F/‘ Ft."Ft. Setback to Ordinary High Water Level 'T/VI Ft. 35" Ft.Ft.Ft. Elevation Above Ordinary High Water Level Setback to Septic Tank IdO Ft. Setback to Drainfield Ft. Setback to Bluff 2j^ Ft. Maximum Proposed Height Ft. Roof Change ( ) Yes ()^) No Bathroom Proposed ( ) Yes ( No Setback to Septic Tank Setback to Drainfieid _ Setback to Bluff____ Total Bedrooms ✓ Ft.Ft. Ft. Ft.Ft. Ft.Maximum Proposed Height_____ Roof ChanjjST ) Yes ( ) No Basem( Ft. Ft. ( )Yes ( )No \ WaUkiut Basement ( ) Yes (side profile required) ( ) ( ) Screen Porch ( ) Storage Structure ‘ Must include on scale drawing, additional Permit may be required. Topoqrat^ical Alteration / EarthmoviM— □ None ® ^ 20 Cubic Yards or Less ‘21 Cubic Yards - 299 Cubic Yards‘□ 300 Cubic Yards or More‘ CHARACTERISTICS OF LOT: /O ACAfSS Srrfi /OOP y.^s;c,oo Total Lot Area (FT^) Bluff (10 Yes.Ft.Water FrontageLot Area Total Impervious Surface Onsite (FT^) Impervious Surface Ratio:Xioo =.%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. ‘T/p.l/oS-Date: CaJ-0 I Signature of Property Owner / Agent for Owner Date; 13 400 PERMIT FEE $RECEIPT NO.PROJECT(S) TOTAL SQ. FT.. fo rgx/rryx/^ PnLET ______________________ % fcA IP ?CJ.6 ^_________________________ pnfej iqpEA C ^ - fzx> X !(J I, ^ C,i-£ArJjfir/0 rhusT' Fr>lL i S/hJO LAUClcAiZd Crp yH L^'irh tmyJiPhiriC) Comments: Form No. BK — 1003-0407 329,582 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota P - Office • jLDENROD -'Inspector YELLOii -.owner (after issue) PINK - Assessor APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 2U3..99e-aQ95'___^------^ www.co.otter-tail.mn.us 3^ -ooo-oS'-cXiT? -oo‘ Permit No.PLEASE PRINT OR TYPE ALL INFORMATION PNAMELAKE/RIVER NAMELAKE / RIVER NO. RoSff u PARCEL NUMBER (S) tr^jy r r LE^ALOEgRPT^N ^ C* SLy iZfuJ of £3 A' UJ L Daytime Phone No.Mailing AddressFirstInitialLast Name ■? C-y ^______________ 'ZJT6:: . /^Ay MiVP(t%S^PProperty Owner l>e/\hiP S‘tAfA/£:__________33</-^/r4T. 6^ MContractor Name Lie.#<;rL ves. ^ , ... TREATMENT SYSTEM /Ia) Individual ( ) Public ( ) None / .. . i jJU U ^ {V) Permit No. >-'-■' ________\_ NOTE: MN Rules Chpt. 4725 (MN Well ( ) OTWMD Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rotlie Mann at 218-864-S533 \PROPOSED PROJECT (please circle the appropriate number) (2) Add’n to Dwelling (5) RCU/Year______ (J) Add'n To Non-Dwelling (8) Storage Structure (10) Non-Conf. Replacement (identify)___________ (11) Other (identify)_________________________ 'Existing Dwelling to be removed prior to__________ ONSITE SEWAGEONSITE WATER SUPPLY ( 3) ‘Replacement Dwelling ( 6) Attached / Detached Garage (9) W.O.A.S. (1 ) New Dwelling (4) MH/YR. Code) requires a 3’ (minimum) structure setback to a well. /xCHARACTERISTICS OF PROPOSED W.O.A.S.. (WATER ORIENTED ACCESSORY STRUCTURE) Outside-, Dimensiort. CHARACTERISTICS OF PROPOSED NON-DWELUNG Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING (Mbqt Include Attached Garage) y'' Outsid^'Qlmension___ Sq. Ft. \ Setback to Lotllhe ___ Setback to Right ohs(ay Setback to Ordinary Hi^Water Lev^___ Elevation Above Ordinary 1^ Wjifer Level Setback to Septic Tank___ Setback to Drainfield___j Setback to Bluff / Total Bedrooms / Maximum Pro^pSM Height Roof Changd ( ) Yes (- ) No \ Basemeru ( ) Yes ( ) No \ WalkfJut Basement ( ) Yes (side profiie required) ( ) Ft. X /60 Ft."T."Ft. X Ft."Ft. X ■So Ft. ZJ400 Setback to Lotline f 2jO Ft. & _t_5_^^Ft." Setback to Right of Way 2-0 Ft." Sq. Ft. Setback to LotlineN Setback to Right of Setback to Ordinary High’MSfat^evel __ Elevation Above Ordinary p^^ater Level Setback to Septic Tan Setback to DrainfjpTd____ Setback to %\^________ Maximurn^oposed Height ( ) Bpathouse ( ) Screen Porch ^ ( >^azebo ( ) Storage Strudlu(e^^x^^^. Ft."Ft.& Ft."Ft.&F/* Ft. Setback to Ordinary High Water Level 2-O0 Ft. 3S^ Ft. /Ft.Ft. Elevation Above Ordinary High Water Level Setback to Septic Tank Setback to Drainfield Ft. Setback to Bluff 2,^ Ft. Maximum Proposed Height i¥‘ Ft. Roof Change ( ) Yes (X) No Bathroom Proposed ( ) Yes ( ^ No Ft.Ft.iOO Ft. Ft. Ft.Ft. Ft.Ft. Ft. ( **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection * Must Include on scale drawing, additional Permit may be required. Topographical Alteration / Earthmovina^ □ None ^ 20 Cubic Yards or Less *□ 300 Cubic Yards or More*21 Cubic Yards ■ 299 Cubic Yards' CHARACTERISTICS OF LOT: /9 /OOP if^r,L,oci Bluff jOt'fesFt.Water FrontageLot Area. T.jS'a .%X100 =Impervious Surface Ratio:T 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 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. S/p.iloSDate: Signature of Property Owner / Agent for Owner /IDate: Land & Resource Management Office _Q ICO RECEIPT NO.PERMIT FEE $PROJECT(S) TOTAL SQ. FT.. /^DVJdA POU ZAAhJComments: PiOOm^r} Tg> BaAcJ \ CCl OP U/.:u\~' /ftHjir r'.TSniirJ t C A fr'{< /.Il£r7 ;-j/c.f ■•■’f i La.'/... /9 ., Of*; („-t< ;/■ / ’ .• ^ / > ri - / /329,582 • Victor Lundeen Co., Prlrtters • Fergus Falls, Minn^otForm No. BK — 1003-0407 Wtl, * H SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Structure Set Back from Ordinary High Water Level "f-Ft.Ft. Structure Set Back from Top of Bluff Ft. Ft. /go 7^Structure Set Back from Road Right of Way Ft.Ft. r~ Ft.Structure Set Back from Lot Lines Ft.Ft. &Ft. 'g JHStructure Height Ft. Ft. Structure Set Back from Septic Tank Ft. Ft./Qi- Structure Set Back from Drainfield Ft. Ft. Elevation Of Lowest Floor Above Ordinary High Water Level Ft. Ft. Land Slope at Building Site 7 % % j/ Inspector’s Comments / Sketch: s 7^ Inspector’s Signore 50^-M £ Date of Inspection I■:Time of Inspection-f- ■fd 6/^ roject ApprovedyrDate / Initial / t T ■«s.» : i w ! T < j :■ ^:v•’ .1 1 .i ^r I ;|; ; 4^' VV.? I.] i i i ! Vi ,'V V >i ri »- )■1; . 4" I 'it i i•1* •V If- ♦ il-.i ■f -O' St, -•i^'A { h } ft- ^ ! -* ;•»;I ■;-• I' i i imm FOR POSSIBLE FUTURE CAmSROUND EXPANSION PURPOSES. : , !! i' IJ 1.”- ■A •;Jf ‘ «! r;. J i: ,:uI •T i S'- f -i. f. Q> [^1r t SURVLTOR: Roy A. Smith and A$sodatea Lincoln Profeaslonal Canlar Defroli Loh9$, Mnnaaola >SCALE I INCH • 100 FEET , E6.2 m denotes spot ELEV. OF 26.2'-R?h (assumed DATUM) ! r •*■"■'f;0 •f ii I .4;■ )r K I /••,t ■ % ..*>.;;■ ,JKI \I hereby certify that this survey, plan,C5f repf^r w^s prf»pared by me or under my d.'f<' and that I am a duly LarKi ;^*rvt'>nr utrder the laws 4 iI >■*». • ai‘i ; r•i ' •;• •I ii*I ♦ . O graphic 100 scale 200 \.;■. r'v'^'*T-/•y'<T*‘ im •d Uj- DaSe/V]^ /3^ /lU. Reel No /tooy :l"fI•f' • W?i i Ivsi«irac«Tr qAjt4« 7\J I r ■,;i Pole Barn Existing site ii oCMKabotaD- -J O §■+->(D O14x6QO X L_-CO ooCMXExisting Pole Barn 24’ X 40’ o Jet Ski ...... 10x6 4x4 Pole Barn 24’ X 20’ X=3 CM in oCl CMccEToro 1.8x6 Skagg XCT5COO8x6 ■t 12x10 Door 3’Door 4’Window 24’ X 40’ Pole Born Proposed Pole Barn Addition Rose Shores Campground DeAnn Anderson hoe* Inc, 65' to Campground Drain Field 120' to Property Line150’ to Campground Septic 130' to House Septic Map and measurements 69' to House Drain Reid 63' From Comer of Existing Pole Barn nS' Prom Corner of Existing Pole Barn 350' to County Highway 4 24'x40' Pel* Barn Rose Shores Campground DeAnn Anderson Estimated/measured Impervious Surface Campers: 25 X 8’ X 38’ = 7600’ Decks: 25 X 8’ X 25’ = 2500’ Bath house: 14’ X 32’ = 448’ Fish house: 9’X 10’= 90’ Well house: 6’ X 6’ = 36’ Steps: 4’ X 24’ = 96’ Pole bam (existing): 24’ X 40’ = 960’ Addition: 24’X 60’= 1440’ House: Slab 24’X 38’= 912’ 68’ X 50’ = 3400’ Upper Driveway: 12’X 600’= 7200’ Lower Driveway: 12’X 675’= 8100’ ::Total surface = 32782 sq ft Acres = 10 = 435600 sq ft 32782 / 435600 = .0752 x 100 = 7.52% ; 'me. , WHITE - Office GOLDENROD - Inspector YELLOW - Owner PINK - Assessor APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 ■. C.P-h C-L 1 L ~S I Permit No.y Q-P / f LEGAL DESCRIPTION y' BLUFF ZONE/AND CrL^ /5*f^too SIS 'S Sites □ NO S)yLOCATION LAKE NUMBER LAKE/RIVER CLASSLAKE/RIVER NAME SECTION TWP NO.RANGE TWP NAME RO ^SQ -^(=>0 PARCEL NUMBER (S)TOPOGRAPHICAL ALTERATION □ YES # OF CUBIC YARDS ^QCno FIRE NUMBER 3Si- -ooo- 02 - oos?-- IDENTIFICATION: Please Print All Information TELEPHONE NO. InitialLast Name First Mailing Address — No. Street, City, State, and Zip Code (Daytime) '^Ia\Cjl\ <cJn ^ S<S¥Property Owner mi/ 5^7 /■^-TNameContractor State Lie. # PROPOSED PROJECT j^^New Structure(s) ( ) Addition(s) ( ) MH/RV____________ PROPOSED USE ONSITE WATER SUPPLY (^Individual ( ) Public ( ) None ONSITE SEWAGE TREATMENT SYSTEM ( ) Individuai Permit #____ ( ) Collector Permit #_____ ( )OTLSD ( ) Dweiiing ('^<Jlon-Dweiling ( ) Water Oriented Accessory Structure (mAS)YEAR CHARACTERISTICS OF NON-DWELLING ( ) Utility Structure CHARACTERISTICS OFWOASCHARACTERISTICS OF DWELLING ( ) Garage P>4^0ther Outside Dimension _ ( ) Boathouse ( ) Screen Porch( ) Dwelling ( ) Addition to Dwelling ( ) Basement ( ) Walkout Basement Outside Dimension__________ PJ^a ( ) Gazebo ( ) Utility Structure Ft.x ^0 S 0^\, & So /90 ( ) Other. Outside Dimension .Ft. .Ft.x .Ft.Lotline Setbacks .Ft.Ft.x .Ft. Ft.&.Ft.Lotline Setbacks OHWL Setback .Ft. Lotline Setbacks ,Ft.&.Ft. (^NoOHWL Setback .Ft.Bathroom: ( ) Yes (If Yes / a complying Sewage System Required)OHWL Setback .Ft. Total Bedrooms__________________ Maximum Height / 30 Ft. (2 story)Maximum Height /10 ft. (1 story)Maximum Height/l 8 F^(1 story) S. 2-' O,Sq. Ft. Impervious Surface Ratio,Sq. Ft. Impervious SurfaceLot Area 3/9QO Ft. (3' minimum)Ft. Elevation of lowest floor above OHWLWater Frontage J2- O Ft. Slope of lot .%Structure setback to right-of-way /O _Ft. (10'minimum) (Sewage System Permit required before installation). _Ft. (20’minimum) (Sewage System Permit required before installation). Structure setback to septic tank Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System Ft. (10’minimum) (Sewage System Permit required before installation). 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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. /(^3Dated: Signature of 'Owner Dated: Land & Resource Management Office RECEIPT NO.PERMIT FEE $ c^s3~-a.-.Comments:/-Po 7^ m ecs-f-Oo c oc ^ f1/y 281,017 • Victor Lundeen Co., Printers • Fergus Falls. MN • 1-800-346-4870Form No. BK — 0496-002 < APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE -Phone:(218)739-2271 • FERGUS FALLS, MN 56537 , WHITE - Office GOLDENROD - Inspector YELLOW - Owner PINK - Assessor '• j c. /5 y O-T /' ;Permit No.I^ L^f * U;y ^ ^ o-f '4^q II . LEGAL y 'DESCRIPTION BLUFF ZONE/AND Cr 5^fuj Sf^ 'S s' Styes □ NO LOCATION -i.' —^ LAKE/RIVER NAMELAKE NUMBER LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME Ru £RoS / J7_(T j. ~ ^ (:>0 PARCEL NUMBER (S)TOPOGRAPHICAL ALTERATION □ YES # OF CUBIC YARDS 5i:TN0 FIRE NUMBER 3^'000- 02-oos?^ OOX.Ho8o^ IDENTIFICATION: Please Print All Information TELEPHONE NO.] Mailing Address — No. Street, City, State, and Zip Code (Daytime)First InitialLast Name ^U<k-fL] > ^Property Owner ^ ^ //A) (2/NameContractor State Lie. # ONSITE SEWAGE TREATMENT SYSTEM ( ) Individual Permit #____ ( ) Collector Permit #___1. ( )OTLSD PROPOSED USE ONSITE WATER SUPPLY Individual ( ) Public ( ) None PROPOSED PROJECT j\j^New Structure(s) ( ) Addition(s) ( )MH/RV____________ { ) Dwelling f^iJIon-Dwelling ( ) Water Oriented Accessory Structure (WOAS)J!YEAR iCHARACTERISTICS OF WOASCHARACTERISTICS OF NON-DWELLING ( ) Garage ( ) Utility Structure CHARACTERISTICS OF DWELLING ( ) Screen Porch .1( ) Boathouse( ) Dwelling ( ) Addition to Dwelling ( ) Basement ( ) Walkout Basement Outside Dimension__________ 1 PJ^a(pother ( ) Utility Structure( ) Gazebo Outside Dimension Ft.x S Oy\.. & So /oo ( ) Other. Outside Dimension Ft. .Ft.Ft.>Ft.x Lotline Setbacks -Ft.Ft.xI .Ft.Lotline Setbacks .Ft.&.Ft.OHWL Setback .Ft.Lotline Setbacks .Ft.& (X)No.Ft.OHWL Setback Bathroom: ( ) Yes (If Yes / a complying Sewage System Required).Ft.OHWL Setback. Total Bedrooms__________________ Maximum Height / 30 Ft. (2 story)Maximum Height / 10 ft. (1 story)Maximum Height Xl 8 F^(1 story) JOOO .Sq. Ft. impervious Surface Ratio %.Sq. Ft. Impervious SurfaceLot Area 3 .Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage O ~ 1-D- O __________Ft. Slope of lot Ft. (10’minimum) (Sewage System Permit required before installation). Ft. (20’minimum) (Sewage System Permit required before installation). Ft. (10’minimum) (Sewage System Permit required before installation). .%Structure setback to right-of-way /oStructure setback to septic tank_____________ Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System 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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. Dated: Signature of Owner /Dated: Land & Resource Management Office ^ ('S'PERMIT FEE $'/ /RECEIPT NO. i '/. / P<' i P .'/e I-Y'l /3-Comments:37^..'u'.<1 c■ ■ ' V i'>Tr-4 t- cP'!-+ r ✓ /3 ^ fc-'., ..7 281,017 • Victor Lundean Co . Printer* • Fergus Fall*. MN • 1-800-346-4870Form No. BK — 0496-002 * : INSPECTION RESULTS )■ Make all measurements and computations i ^00''Ft.Structure Set Back from Ordinary High Water Level Ft.1 Ft.Ft.Structure set Back from Top of Bluff /OO^Ft.Ft.Structure Set Back from Road Right of Way 5o^50^Ft.Ft.Ft.&,Ft.&Structure set Back from Lot Lines gas/s- S<7+ Ft.Ft.Structure Height Ft.Ft.Structure Set Back from Septic Tank 3c:?Ft.Ft.Structure Set Back from Absorption System Elevation Of Lowest Floor Above Ordinary High Water Level____________________Ft.Ft. %%Land Slope at Building Line VInspector’s Comments / Sketch: Ir Inspector's Signature [jflt^i^rinspection -'i 4 fcf Ti^pe^ef-Tffspection . 'J. White -^’Office Yellow — Owner PJnk — Assessor Goldenrod — Inspector t SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT ^(OUSE Phone: (218) 739-2271 — Fergus Falls, Minnesota 56537APPLICATION POR/sITE PERMIT ST?/Permit No___LEGAL DESCRIPTION AND LOCATION 9’o 7^TWP NameTWPLake Classif.Sec.RangeLake NameLake No. tPENTIFICATION; Please Print All Information Tel. No-Zip No.Mailing Address— No. Street. City and StateFirstInitialLast Name —V—,Owner / NameContractor 7 Architect Name. NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE DFIMPROVEMENT: (^^New Building ( ) Alteration Specify:,( ) On^Family Dwelling lie Dwelling yyr( ) Ml Units ( ) Other Other Size ESTIMATED COST OF IMPROVEMENTS TYPE OF SEWAGE DISPOSAL:DIMENSIONS:PRINCIPAL TYPE OF FRAME: ( ) Yes (^ No( ) Masonry Frame ( ) Structural Steel ( ) Other — Specify ( ) Pyblij Basement: .r<.Stories above basement: Sq. feet (outside dimension) Bedrooms (ndivfdual Septic Tank, etc. WATER SUPPLY: ( ) Public ( ) Individual Well Baths CHARACTERISTICS: Jojyy..Maximum depth of lotWater frontage is feet.square feet.Lot Area is /L7 a feet. (Building Line)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 3..feet 53..feet.feet — from road right of way is /c/Z.y.............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 / 0 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 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. J/Dated. 7 OwnerSignature 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. 5-fDated Shoreland Management Official Permit Fee % 3 0 Receipt No. Comments: Form No. MKL-0286-019 229971 @ VICTOR LUNDEE.N CO.. PRINTERS, FERGUS FALLS. MINN. •-5-WWhite - ’office Yellow — Owner Pilnk — Assessor Goldenrod — Inspector SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT (W> y y /Permit No,.LEGAL /..V DESCRIPTION AND LOCATION /i/ TWP NameSec.TWP RangeLake Classif.Lake NameLake No. IDENTIFICATION: Please Print All Information Zip No.Tei. No.Maiiing Address— No. Street, City and StateFirstInitialLast Name Owner NameContractor Architect Name. NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT: Specify:.( ) One Family Dwelling ( ) Multfhle Dwelling ( )Other ( ) New Building ( ) Alteration IUnits ( ) Other Size ESTIMATED COST OF IMPROVEMENT $ DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME: Basement: ( ) Yes ( ) No Stories above basement: ....... Sq. feet (outside dimension) .... Bedrooms ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public ( ) Individual We|( ( I Masonry ( ) Wood Frame ( ) Structural Steel I ) Other — Specify i Baths■ i CHARACTERISTICS: Water frontage is ....J... .--y » feet.feet.Maximum depth of lotsquare feet. 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 .............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 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. -1/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. Dated Shoreland Management Official Permit Fee $.Receipt No. Comments: I Form No. MKL-0286-019 229971®VICTOR LUNDEEN CO.. PRINTERS. FERGUS FALLS. MINN. INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 1 MINIMUM Shall Be Sq. Ft, lALot Area (Square feet)'Sq. Fr Sq. Ft. lAoWater Frontage Ft.Ft. ±J60'200Building Set Back from High Water Mark Ft.Ft. /’V pj_Building Set Back from State Highway 50 Ft. 9^0> Ft.Building Set Back from Street or Road Ft. 10& /^^Ft.& Ft.Side Yard 5^^-fRear Yard Ft.Ft. f\joAr&.Occupied Building to Septic Tank Ft.10 Ft. Occupied Building to Absorption System Ft.20 Ft. Elevation at Building Line above High Water Mark_____________3 Ft.3 Ft. Inspector's Comments: I ^ J /y ^ ^ JQ^<rtJla2 I t I > 2a Inspector's Signature Title Inspection Dated 10- ^19 Agency VICTOR LUMOICa 4 C» . RRIRTERt. MR4U4 FALLS. NINM. i / is / I T" 3d 3d3C''T« Iri■1.1. f 1.^/T SL 0 •‘J ! /~< "'nI / V\L~■"l I / ' 0 <r9•t)S ^ k () Djd t 5^Oi'vcr :^ 3C-" i I \,1 1/ V / r'I / ^ / \ V”S\//I ^ c/\\r.10 \/^ L 0'^ ^ ^ /; [Z u I \f fo I. f - /'b X \0/ODcy <J rO UX/"/V o5 0 /n_r —■ '"W ‘White - Office Yellow — Owner Pink — AtteseorGoldenrod — Inspectpr _ ^ ■?SHORELANO MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT I ' ■" / ■! Permit No„LEGAL Pi Q,L.q fl(.- '^(fO l)ake 1^0. ~____________Lake Name______ DESCRIPTION AND Sec. 'tWP Range TWP Name LOCATION Lake Claatlf. IDENTIFICATION: Pleate Print All Information Tel. No.Zip No.Last Name_______________________First Initial iiyng Aodress— no. btreei, uiiv ano ^Taie/103, \ gcr?Owner 2M1■v NameContractor Architect Name.3£TZES!Z i 'I NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT: ^...-^^yDne Family Dwelling ( ) Multiple Dwelling \ Specify:c?(Udzreew Building ( ) Alteration UJUnits ( ) Other Size( ) Other ESTIMATED COST OF IMPROVEMENT|$ DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME:Jk^Yes ( ) No ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public ( ) Individual Weil Basement: Stories above basement: Sq. feet (outside dimension) Bedrooms .............................. ( ) Masonry ,^^^ood Frame ( ) Structural Steel ( ) Other — Specify Baths CHARACTERISTICS: M^a^il^Kifrr depth of lot feet.feet.Water frontage is ...Lot Area is IQL.feet. (Building Line)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.... and feet •feet.feet — from road right of way is lQ............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). Side yard is ........ zStructure will be located mStructure 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 prart 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. I JLAJ\^Signatureo7^0wDated. ner Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon the 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 nevoked at any time upon violation of said ordinances. Dated oreland Management Official^0?Permit Fee $.Receipt No. (TvTHtD ^ Comments: CCmSrhrOC; p 06CU^ Form No. MKL-0286-019 229971@ VICTOR UJNOECN CO.. PRINTERS. PEROUS PALLS. MINN. w White - (Office Yellow — Owner Pifik -- 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 r 1HDESCRIPTION AND LOCATION TWP NameTWPRangeLake Claiilf.Sec.Lake NameLake No. IDENTIFICATION: Pleaie Print All Information Tel. No.Zip No.Mailing Address— No. Street. City and StateInitialFirstLast Name Owner NameContractor 9r<^ Architect Name, NON-RESIOENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE;TYPE OF IMPROVEMENT; ( ) One Family Dwellirtg ( ) Multiple Dwelling ( )Other Specify:.( ) New Building ( ) Alteration Units 3^Size( ) Other ESTIMATED COST OF IMPROVEMENT $ DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME: Basement: ( ) Yes ( ) No Stories above basement: Sq. feet (outside dimension) Bedrooms ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public ( ) Individual Well ( ) Masonry ( ) Wood Frame ( ) Structural Steel ( ) Other — Specify Baths CHARACTERISTICS: feet.Maximum depth of lotfeet.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) feety .feet.feet — from road right of way is .............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 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. Dated Shoreland Managernent Official Permit Fee $.Receipt No. Comments: Form No. MKL-0286-019 229971@ VICTOR UiNDEEN CO.. PRINTERS. FERGUS PALLS. MINN. *» INSPECTOR'S CHECK LIST Make all measurements and computations ACTUALIS X MINIMUMShall Be i Sq. Ft Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft. Ft. 7 Building Set Back from High Water Mark Ft.Ft. 50 Ft.Building Set Back from State Highway Ft. Ft.Building Set Back from Street or Road 40 Ft. )d & Ft.Side Yard &Ft. Rear Yard Ft.Ft. Occupied Building to Septic Tank 10 Ft.Ft. Occupied Building to Absorption System Ft. 20 Ft. Elevation at Building Line above High Water Mark_____________I // o Ft.3 Ft. HIInspector's Comments:t;1 \J 1F=---- {y irispdctor's Sijinature .( Title Inspection Dated 19 Agency vier«« uiasiCH « en.. mintc*!. Pf*«ua r«x*. A • feet/inches GRID PLOT PLAN SKETCHING FORMScale: Each grid equals 19Dated:Signature Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. Lc-h■H- c 5^ o 5-^ hISO foO I I' rf 7^ ///I g il5987(^MKL-0871-029 vicToi* v.un6EIU C0