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Rush Lake Resort_53000230140001_Shoreland Permits_
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 WHITE-Office GOLDEfJROD - Inspector YELLOW - Owoer (after issue) PINK - Assessor Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. /v/TWP NAMERANGESECTIONTWP NO.LAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO.////13*5 03^ lai^Tovai$U)i|[>^360RuSti late.7^PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) <^300O'2-iC>\'\(X>O[2>b\Hb RiA^vi L«<re. Loo^? LEGAL DESCRIPTION Sl. 3 Gl. 3 f *4 EV Ttz. Daytime Phone No.Mailing AddressFirst InitialLast Name ?L __ Shcv€A/tWjMM fe\-33^?S02Property Owner Viar\o(AY(A. „ , ^ PO &pyi ________fetW, PtthiW KANJ PC 034 MW____________ - - Contractor Name Lie.* uPROPOSED PROJECT {please circle the appropriate number) (1 ) New Dwelling (4 ) MHA'R (7 ) Add'n To Non-Dwelling (10) Non-Conf. Replacement (ider^tify)"______________________ Other (identify) g.xV^\\Y\(^ rAvJdeU\Yg/N)euv Cs (12) Deck__________________________________ (13) Fence ONSITE SEWAGE TREATMENT SYSTEM ( ) L&R Cert, of Compliance withic 5 yrs t>^ Compliance Inspection Report within 3 yrs. / ' (Attached) ■ \R> * ( ) OTWMD ’Must have Sewage System Approval from OTVyMD prior to issuing Site Permit. Contact Rotlie Mann at 218-864-5533 ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure etback to a well. (^Replacement Dwelling* ( 6) Attached / Detached Garage ( 2) Add’n to Dwelling ( 5) RCU/Year______ ( 8) Storage Structure (9) W.O.A.S. "Existing Non-Conf. Structure Verified by L&R•Removal of Existing Dwelling Verified by L&R Inspeclor's Initial/Dateinspector's Initial/Dale CHARACTERISTICS OF PROPOSED Wre^sT ^(WATER OniENTCD AGOCOOOnV STWUCTUnE) Ft.x Ft." ^ 0 CHARACTERISTICS OF PROPOSED DWELLING Q. )cHARACTERISTICS OF PROPOSED t^aT-DWELLING (Must Include Attached Garage) y Outside ^ /3 O Ft X *3 "2- Ft" Dimension ^0 Ft. x lO Ft.** Y Sq. Ft. Setback to Lotline Setback to Right of Way loSj (o Ft.** Outside DimensionOutside Dimension Sq. Ft. , , » /I dt 3^/;^ Ft. & /OS' S Ft.**Sq.Ft. „ . n / Setback to Lotline lO Ft. & I Ft.** ^ Setback to Right of Way 1> Ff.** ^ Setback to Ordinary High Water Level \^l Elevation Above Ordinary High Water Level Setback to Septic Tank Ft. Setback to Drainfield |3\0 10 Ft. Setback to Bluff Ft. Maximum Proposed Height ( ) Screen Porch ( ) Storage Structure Setback to Lotiine Setback to Right of Way fc^2.i0 Ft.** Setback to Ordinary High Water Level Elevation Above Ordinary High Water Lev^__f:! Setback to Septic Tankl^ ^ Setback to Drainfield 1*'^ Ft. Setback to Bluff fS/A Ft.&V Ff. _ / t*FC Setback to Ordinary High Water Level __; Elevation Above Ordinary High Water Level S G Ft.*^yFt.y ^Vt. ^Setback to Septic Tank Setback to Drainfield M3 T Ft. y 7a M A Ft. TcffPtV B€*dl»ioovy>^Total Bedrooms Setback to Bluff Maximum Proposed Height jh Ft.\M- Ft.3-Maximum Proposed Height Roof Change { ) Yes (*)(^) No y Basement ( )Yes (y) No Ft.JRoof Change ( ) Yes f^) No Bathroom Proposed ( ) Yes ( ) No >/( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / inspection Walkout Basement { ) Yes (side profile required) No y * Must include on scale drawing, additional Permit may be required. Topographical Alteration / Earthmovinq □ None □ 20 Cubic Yards or Less * V 21 Cubic Yards - 999 Cubic Yards □ 1,000 Cubic Yards or More* y.Sb Bluff ( )Yes ('^NoCHARACTERISTICS OF LOT:Sq. Ft.Water Frontage Ft.Lot Area,ylO. SIfeUn/.%.% 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 Land & Resource Management office once the building footinas have been constructed. ililH inDate: SignatuT tr / Agent for Ownt! A A X JiDate:\ Land & f^source Management Omcial ____________________________________________________^ m OuPuSir ( j- /wu- UJtTih,) _______Fpori4)G ( C3AMt <(T) REfiLAcf. N-£>i4<S C££.B CotlM^jfUL. mPERMIT FEE $RECEIPT NO.PROJECT(S) TOTAL SQ.FT. Date StampComment RECEIVED 1^1^Form No. BK — 08-015-2013 352,196 * Victor Lundeen Co.. Printers • Fergus Falls, Minnesota /4-^ Q\^ Wi Z‘ APPLICATION FOR SITE PERMITWHITE - Office 'I GOISjil^OD • Inspector 'f’ELLOW - 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 ! Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. RANGE TWP NAMETWP NO. .LAKE/RIVER CLASS / SECTIONLAKE/RIVER NAMELAKE / RIVER NO. -y/T"•ly (. \>'’st,.- y'ik.AVL...1I yPROPERTY (E-911) ADDRESS \ kD V~ -^ V ,> Lvt t C L' ^ PARCEL NUMBER (S) r 1 l LEGAL DESCRIPTION ■i • aL 3 f ^ Tm.■7. • t Daytime Phone No.Mailing AddressFirstInitialLast Name rk£j_UOl' \Property Owner r'L-p;, ji 'w A SPt. vi_ \ j c i V ^ N1M 12 - ■ i I i j P D \ y j / / jcContractor Name Lie.# ii IAn. I- i ft IteW Ormr.v -iMl7L_StSl_Rk L tL .VVL-+p,' \ONSITE SEWAGE \TREATMENT SYSTEM ; y I ( ) L&R Cert, of Compliance withip 5 yis, , - f>4 Compliance Inspection Report within 3 yrs. , (Attached) ^ ( ) OTWMD ‘Must have Sewage System Approval ] from OTWMD prior to issuing Site Permit. Contact Rome Mann at 218-864-5533 \PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling (4) MH/YR (7 ) Add'n To Non-Dwelling {10) Non-Conf. Replacement (identify)" CP Other lidentifvIH. .. (IT) Deck______________________ (13) Fence_____________________ ONSITE WATER SUPPLY P:') Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. i (]3) Replacement Dwelling' (6) Attached / Detached Garage (9) W.O.A.S. (2 ) Add'n to Dwelling (5 ) RCU/Year______ (8) Storage Structure I t ^ L tu Jk: - ~ •t .t "Existing Non-Conf. Structure Verified by L&R'Removal of Exisfing Dwelling Verified by L&R Inspector's tnitial/OateInspector's Initial/Date ■ i i CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) Outside Dimension Sq.Ft. i , . ^ ^ ^ . .. Setback to Lotline I ir, 'f\ Ft. & b Setback to Right of Way ir, S2. i 0 Ft." Setback to Ordinary High Water Level Ft. Elevation Above Ordinary High Water Lev^. H' Setback to Septic Tank I* T Ft. ^ Setback to Drainfield !2 7't 'Ft. ^ Setback to Bluff Total Bedrooms Maximum Proposed Height Roof Change ( )Yes ( x)No y Basement ( ) Yes ( y) No Walkout Basement ( ) Yes (side profile required) ( , ) No CHARACTERISTICS OF PROPOSED W.O.A.S: (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension (CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension Sq. Ft. \ yy Setback to Lotline Setback to Right of Way ir-S it (' Ft." Setback to Ordinary High Water Level __i Elevation Above Ordinary High Water Level S L. Ft. Setback to Septic Tank 'i’‘i • ') Ft. Setback to Drainfield ^ Ft. Setback to Bluff i' -i r'< Maximum Proposed Height jh Ft. Roof Change ( )Yes fy')No Bathroom Proposed ( ) Yes ( ) No V f i'-: Ft." V Ft." Ft." Ft. x\Ft.x f Ft." '''Ft. x ' .. V /NlJ~1'1 Ft. & ^ ‘• j . Ft.Sq. Ft. Setback to Lotline Setback to Right of Way Ft." Ft.& K. ! Ft." Y"f y a^Ft.I ✓Ft.Ft.Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level j rr- Ft. Setback to Septic Tank ^ ^ 'I Ft. i/ Setback to Drainfield i ! ■ Ft. ^ Setback to Bluff LOA Ft. Maximum Proposed Height ( ) Boathouse ( ) Gazebo v'/i Ft, i/ Ft, 'K >iNl , ,'Lt^.\M Ft.3-/ y ?! ( ) Screen Porch ( ) Storage Structure V i**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection 1v/Topographical Alteration / Earthmovina □ None * Must Include on scale drawing, additional Permit may be required."X 21 Cubic Yards - 999 Cubic Yards□ 20 Cubic Yards or Less '□ 1,000 Cubic Yards or More* 7 )Bluff ( )Yes (y)NoCHARACTERISTICS OF LOT: Lot Area j L - ' Sq. Ft.Water Frontage Ft. */% \/.%1 iBuilding Surface Ratio 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. j 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. Date: / ' ') / ^ '7_______________________ | r-'U\i^ f jo i-^ Uj Fiji ■ ‘ Signature of Pfo^^ OwnSr / Agent tor Ovfn»I \ \ ■ . s/ y 'U ' L‘i if/: ----,---,-----------------Land & f^source Management Official \ 1rii'v \ .i ^{ A A yDate:-J (Y\riM PERMIT FEE $PROJECT(S) TOTAL SQ. FT.,RECEIPT NO. Comment^ /T) C Sl]' jfia. '^7. 4— /~ILL. UjlTUlpJ '!Ham 1 1■I R rrtrii. ^ lyr.Li^ i-i { <- j fr !IL. y ‘ ■. ; 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 IGm Cc~h iW 'If'-Structure Set Back from Ordinary High Water Level Ft. Ft. Structure Set Back from Top of Bluff «r Ft. Sloe'Structure Set Back from Road Right of Way Ft. Ft.&1^Structure Set Back from Lot Lines Ft.&Ft. Structure Height Ft.Ft. structure Set Back from Septic Tank Ft. Ft. Structure Set Back from Drainfield Ft. Ft. Elevation Of Lowest Floor Above Ordinary High Water Level 3Ft. Ft. Land Slope at Building Site % U/V jInspector’s Comments / Sketch: O V\ ^ tij*h<' Xt0i\j lO >3^ iT Ll C Ll I 4/i mS-- inspect<jr’s Signature Da^3f InspectionCcX~)'^'^SCcrKov^ w/f^4+oW CooSV'^A.Crti \\\^|^^ ; av<_ (oo pU/v,pb,j^^. o/~> Ov-N, op-Time of Inspection WHHjA'C Date/Initial '□ Project Approved. r I I SCALE DRAWING F0RM w IIIb'^6('X)'3.'\oi^fnnn\Tax Parcel Number(s) The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing ^nd/or proposed structures, septic tanks, drainfields, iotiines, road right-of-ways, easements, OHWLs, welis, wetiands, topographic features (i.e. biiffs), and onsite impervious surface calculations. /"--S-Q'-O"I %rImpel'vious Surface patioScale ^e Worksheet (|i(Must CompI n Other Side) l!I i; II I ILOrEXTCKTS ANonfeR RS.TTlyr.est' II I f r" ■z'I II I I T 4-1 • III IIJ III 1IIzI @ IIII t I ,1, II IfII Existing III I I I I I I ;I ^ X 4^. I2^. I IHECefVED to 31 !I 7r ’.it. ii i D ! sI a I Signature of Property Owner Date BK — 0909 Victor Lundeen Co. Printers ■ Fergus Falls, MN 1-800-346-4870 '=7, IMPERVIOUS SURFACE CALCULATION WORKSHEET: List of Onsite (Existing and Proposed) impervious Surfaces (must be shown on scale drawing): ‘7.0/^Ft2Structure(s): Ft2Deck(s): Ft2Driveway(s): Ft2Patio(s): Ft2Siclewalk(s): Ft2Stairway(s): Ft2Retaining Wall(s): Ft2Landscaping: (Plastic Barrier) Other:Ft2 7^ ^7^6 Ft2TOTAL IMPERVIOUS SURFACE: Ft2LOT AREA: .%X100 = TOTAL IMPERVIOUS SURiPACE IMPERVIOUS SURFACE RATIOLOT AREAI y I SCALE DRAWING Ff)RI\/|i tnlp 5 3o00’2 3014000^I Tax Parcel Number(s) The scale drawing must be a signed drawing which includes and Identifies a graphic scale (feet)( all existing ^d/or proposed structures, septic tanks, drainfields, lotlines, road right-of-ways, easements, OHWLs, wells, wetlands, topographic features (i.e. bluffs), and onsite impervious surface calculations. 1 = 4b' 0 Impef/ious Surface h (Must Compleje Worksheet Op Other Side) %Scale atio !i I iI I I 1I LOT exTCMs WS.TT NO- 02.' W I z$ “IP 1 ! Z $ Iiii !-T ! fI j„ EXtSTTN^ i...["II..1 ; ;.....r r r i I X 40" "r^'1 I i - 7 1Si^ature otPropej^ Owner Date i\I BK — 0909 Lundeen Co. Prir^ers • Fergus Pails, * 1-800-346-487033a&96 • VicI IMPERVIOUS SURFACE CALCULATION WORKSHEET: List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scale drawing): Ft2Structure(s); Ft2Deck(s): 3| \0 Ft2Driveway(s): FPPatio(s): Ft2Sidewalk(s): Ft2Stairway(s): Ft2Retaining Wall(s): Ft2Landscaping: (Plastic Barrier) Other:Ft2 : ■lasfci'^ X100 = itf.si(jiSk Ft2TOTAL IMPERVIOUS SURFACE: LOT AREA: c .% IMPERVIOUS SURFACE RATIOTOTAL IMPERVIOUS SURFACE LOT AREA Pre-Application Site Inspection Request NOTE: Onsite Inspections will be done between April 15*^ & October 1®*, unless the Land & Resource Administrator determines current weather conditions are suitable for onsite inspections.Assigned To/Date: Lake / River No.Lake / River Name Lake/River Class Section Twp Name 23Q L)R-AjR lave Parcel(s) No.Property (E-911) Address 23(^HooO\[M€ L-‘^ Property Owner Information: Name(s): PL tSa-CLcJ\ ^S/yMr Address: l 3X.. VioU-^ j K'\s ^ VC- Daytime Phone: Type of Request: Bluff: Date Stamp „ Verify SetbackDetermination Stake Setback RECEIVED MAR 3 ] 2^:4 •^NDiRisoufJCE v/OHWL:Determination Stake Setback Verify Setback Building Line:Shore Impact Zone:Verification Stake Setback Wetland: Shoreland Area:Determination Determination Soils:Restrictive Layer Determination / Vertical Separation L&R Initial Describe Request: FiriutAr d>a\kJL a r^C olwpWx bid. A scale drawing must accompany Pre-Application Site Inspection Request & request must be staked onsite 0\^b} Property Owner Date INSPECTION COMPLETED (Inspection must be done within 10 days of receipt): U'3 Date Property Ownerfvlotified InspectorDate Onsite IFee:Receipt Number: Inspector must provide site drawing or field notes on other side. - mbowman Application & Forms Pre-Application Site Insp Request Form 06/2012 D Uf ~/0 ~ ioM. 10 ^V' ^ » *•* ♦ Cvj<^hi d-f^' tn Y^>^(5^1, f' li^ A !) •' «»• *\'1^ u17 f sA Sj (. A c>03^-, \Cj?_fM^ll icd.\J^ APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE r- Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessor / j >^0 Permit No.LEGAL O DESCRIPTION 6+ & L 3 s4 AND LOCATION 1 ^fJ^Oc SECTION TWP NO.RANGE TWP NLAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS Of13^ 37 7Of FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER (S) iU{. 3 > 6/ ^'b -odD (^/7^ir^J j //3 IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and State_____,Zip CodeFirstInitial Telephone No.Last Name mProperty Owner 04- /7S'^ NameContractor State Lie. # NON-RESIDENTIAL USE CHARACTERISTICS OF PROPOSEDPROPOSED PROJECT ( New Structure ( ^ ) Addition ( ) MH/RV PROPOSED USE RESIDENTIAL USE (On© Family Dwelling ( ) Multiple -Dwelling # of Units ( ) Garage 3^)’ X'VcZ-Basement l/J&) Walkout Basement ^0) Outside Dimension of Structure______ (^) Residential Non-Residential ( ) Utility Structure /fSWiT) Water Orientated Accessory Structure( ) othi;*^^ (Ft.YEAR 30 Ft.ONSITE SEWAGE DISPOSAL SYSTEM TYPE OF FRAME ( ) Masonry ( yiWood ( ) Structural Steel ( ) Other ONSITE WATER SUPPLY ( ) Public ) Individual ( ) None Height of Structure. # Of StoriesOFFICE USE ONLY 1) Bluff Impact Zone ) Shore Impact Zone ) Sensitive Area ( ) Public ( ) Individuai Permit #.( ) 0TLSD*^7^^ (# Of Bedrooms 3^i \If Of Bathrooms ( LOT SIZE AND SETBACKS:XU3 Atrs /SoLot Area is square feet. Water frontage is 75____ feet. Maximum depth of lot feet. Building set back from ordinary high water level is feet. (String Test) Land height above ordinary high water level at building line is 3> Building set back from road right-of-way feet. Slope of lot % .20 feet. Lot line setback is feet. /VStructure will be located feet from septic tank (Sewage System Permit must be obtained before installation). in.Structure will be located feet from soil absorption system (Sewage System Permit must be obtained before installation). Agreement: I hereby certify that the information contained herein is correct and agree to do^Ule proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Taii County, Minnesota. I further agreenfmLany plansjmd specifications submitted herewith shail become a part of this permit application. I also understand that this permit is valid for a period of six (6) rnttfiharfO /' !' THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMl "SET/PORTH ItrCHAPTER 16, MINNESOTA STATE STATUTES. / iMDated: Signal^ o\Owner 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. J5Dated:y&Land & Resource Management Office m>4^9Permit Fee $.Receipt No. IAlTi h~h htte..hv I-}-93Comments: f) /I ^ 9f /2 harIrsf)lM.S - ih'hcK.} ■¥: V 5 - 6? X ^ ^ “hHUjO 30t<3L' f OeclrD&nnS cc-kl«.r (^n^U'hecl tVlU //ySeiA)ef P. '-bW C_( C.‘>n \V\V W''Y<^^2.^6-vi™X^eenCa!^rint^.'FergusFalirMinnesota I V-o 4-Vv^ piY r»%''Y ^oKAt) by ?>\HForm No. BK — 0292-002 APPLICATION FOR SITE PERMI LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, M <jOlDENR0D — Inspector YELLOW — Owne' PINK — Assesior frcl B o-T Su6 /,/ 3 (P, 13 LEGAL DESCRIPTION G L 3AND njiCATION /”/ SECTION TWP NO.RANGELAKE/RIVER NAME .LAKE/RIVER CLASSLAKE NUMBER 3^C!^t? 13 FIRE OR LAKE ASSOCIATIQPARCEL NUMBER (S) 14. -3^3 - d/^d-odd & IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and State_____,Zip Code Telephone No.Last Name First Initial K.S c3»Property Owner -f- ii, A Lrk /7S-^i NameContractor State Lie. # PROPOSED USE RESIDENTIAL USE (One Family Dwelling ( ) Multiple Dwelling # of Units ( ) NON-RESIDENTIAL USE Garage Jy X Vr>2. ) Utility Structure //sYclYy ) Water Orientated f Accessory Structure ( ) Otlier‘“^" CHARACTERISTICS OF PROPOSEDPROPOSED PROJECT ( New Structure ) Addition ( ) MH/RV Basement Walkout Basement Outside Dimension of Structure______ () Residential Non-Residential (r (Ft.YEAR 20TYPE OF FRAME ( ) Masonry ( >OWood ( ) Structural Steel ( ) Other ONSITE SEWAGE DISPOSAL SYSTEM ONSITE WATER SUPPLY Height of Structure. # Of Stories Ft. ( ) Public OFFICE USE ONLY j) Bluff Impact Zone ) Shore Impact Zone ) Sensitive Area ( ) Public (Individual # Of Bedrooms ( X^) Individual Permit #( ) OTLSD-^^^ ” ) None # Of Bathrooms ( LOT SIZE AND SETBACKS:^./3 A^fs 1^0Lot Area is square feet. Water frontage is.feet. Maximum depth of lot feet. 75Building set back from ordinary high water level Is Land height above ordinary high water level at. building line Is - 7> 70___________ feet. (String Test)\ ■ Si. feet. Slope of lot % Building set back from road right-of-way..feet. •-T Lot line setback is feet.<■ /OStructure will be located feet from septic tank (Sewage System Permit must be obtained before installation). 7/2.Structure will be located feet from soil absorption system (Sewage System Permit must be obtained before installation). Agreement: 1 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. 1 further agree that any plans .^nd 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 ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAJ^TER 16, MINNESOTA STATE STATUTES. \ J A (^^nerDated: Signature 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. £Dated:7 Land & Resource Management Office . r,///VPermit Fee $ 5^Receipt NOv * ~P-l-93CnmmRnt.f [/a. T i !f7~ lifl _____Q 77 - 7—Cg-km 5- "t\.Q{A) "Zn'x .3 L' f H- fi'f' Q/>d. ^7 Bfi hrrt ~ JLO '^0 7^ - u/Uf ^ Lihs - ) Iff n/)JSen)£if — Victor'I.undeen Co., Printers, Fergus Falls, Minnesota ^ 0J) 1^ I A. C/t^ ^ /2 .g^nL.L.453 .7Fn\ /T^7 s^L'i~.ec7 t^Jt!! /->X //f 7J 4-0 ir.^*. V ^tegi, bz B K-J -rri- - fi-C >Form No. BK — 0292-002 •w —>«-V '.JB • ■ ’ V— -?.INSPECTION RESULTS Make all measurements and computations ACTUAL MINIMUM Sq. Ft.f 1/jLot Area (Square feet)Sq. Ft.Sq. Ft../ y/Water Frontage Ft.Ft. f I \UbBuilding Set Back from High Water Level Ft.Ft. Building Set Back from Top of Bluff Ft.30 Ft. (oOC^Building Set Back from Road Right of Way Ft.20 Ft. (0.7'S2.Building Set Back from Lot Line Set Back Ft. &Ft.Ft. Building Height Ft.Ft. 7oBuilding Set Back from Septic Tank Ft.10 Ft Building Set Back from Absorption System 7o Ft.20 Ft Elevation Above High Water Level at Building Line 3'3 Ft.Ft. 0^Land Slope at Building Line % 3o ’ XM S'Inspector's Comments: Sketch: ^7- 4x) /o4r I 3^ -i^c/ -4-sits^ loo'' P Pf «'l*J ( (filo t) Tl. Inspector's Signature f- Date of Inspection 11.^0 Time of Inspection m z\ [3 (5 1,;■ k;i;^. iV cle^rv a_12S^l :^L ^ K/y ^ •n : 1 :s ISL«^1-------1 3 ;i«»s ??I 1J I s 1— ‘I Bel?>S'ffjri0>*J 5W \1' ==^I @-l 0If S2 I?JU [ ;■< i(' --V.C3.Si s2 6 VV \ ^7 \ ¥J.I \ 3C < jl Ci\ytJ)y. *5^I s \1t“l''Io 55 J I1I \§ PEE A«'Sa Sw ihg!Co ^s J/'«I> r0»‘ 1115:4el!^ L.B' >3-V '^\S. 7 5 'C JA. oLH f^sUI ■€ oV 'j-($,-i^‘— 1 CcWA A-e uJ O^ E 'tf6b^ ^) Irdk Fi/I Y e// U I tY / /i- otys orl~i 0—^ 13, y •fr) d ^ yC -j-P ^ U I FJ. \ Oc\ /‘?‘>v "/b EBBIff |g p' I 8B9d l}j' C\ v-<v ^ land & RESOURC f 6>!2- 7^^" !i i i !' cX 'AA £2;7\t^e_t'V.t>/tft 5U. /EZA :f24Sf:r fo<oa«^-Cl1^ Iu,i31 J6Ut>s^7a>OS* Ji-e^iJ?3 / 6 JliI'pO.^ C"^Q\f^ ^CaL,Cst.<7k_—i. :h^aJro /i-g {t-O/2 pu^ Sy. > /ut t \ ■'— (>cU^ rX Sp ^&±Ca* <■•Px~c zEl f QtitA )w\j\. —5C i- 1 loi A c r/*»A !<!>*>*• *!.«<*«■ ~>r fc«v S LkXiik2/>(5 <31^2. ItV <5Li-^~tta /' rij V- rr 71;.. tj APR :! 3 1995 'MllJL^X j<:e #^f)=lft/ 52 2i Si'-^ti &AL£.C JVJhTVVI^M 5S";5.X L-o' utti f' V hrA^-'f—r-r '^yt»4t ') A.A,A' >)ow.:k-<? «=6-^<L^~Z^•TO/>0ti > 12 y- 2 />-f^jtdDti^^5 rU"''VESt32 i2 ;ai-3 iJc ) l\fz J IS > -S n “I »P»M ?/|. atlMpmO M3U| 0) sbs r K60-6T ON NOIlVt*OdM03 0V3M 3Hi»euonMia y 90ZLQ T 'N'H138VZm ' 03 N0N«3A*M f 3'S Lai-Q -t'-f-^<- \j Bii;?v*^w LA^o w '' ■ • ■ r-t.ir. V\ Ki. f*U^JT 4' >(ri 5<:r g5 © 3 3 \ \/ t (Sfe ■V ■S n U! »P«W J#i. •lIMpenC) M»| 01 sDs » ^ZeO-61 "ON N0UVMMM03 0V3M 3KL >o V 80ZZO T 'N‘HiStVZnS * 3 NQNtl3A M t ^ T Ltnmf-&5*^ f if 2\ e:}u'cl»/i^; <:rw 3^r 7H ‘k;!^>-2|^ui /(i f 2-b -t 1 I•f I5 u-r |—3 r~;t;;7I1(V .1 itJiI|f.ecl?>I ;I A1"'!•@-|1 f S2o--a IIuJ- E3.-r s;^j-j,so 6 V \ l! \lliuJ \ JC <iT- 5 i lyivEI <<^*** XeiL*f?5L_ s \-I i z- 1 1J V\\\ ?f—ItCQ «|J(65 s:ihs I^O.di /2_s liI3 V-4 i K OTTER TAIL COUNTY Grade & Fill Permit f_ *^a>SO V+ 10^2, OWNER’S NAME: S^^7L/ SC-«.vMO 7c SUarcNiVts; (v\fj S^(ZGAddress1 Location:^<<\!ien A3 Twp ll^ Range 3*; jwp. Name^^sH U< ^Ag-eGc ^ Q*c Sv^^ UtfT 3> q (j>L • “S 4^________ Lake No. I.ssued 19 ‘’V , Expires _19^ Work Authorized Frc^ Vo'x ro S/<Ll o-P f<-Soirt- 2^ V are.q o O fs) B Stds. cr 1 fllytoy b/\ yc,so y^'lr . TYWAST ST“<^ ^ \?e\.qyf b rus S \’\r^ 0 r\ "W- \-l-, 3 FiH \D«-4“>ra<v% C<^W\/^ <« as ----^—Kq—v>\vH;>a.v\——y-*~ >----------------------------------- NOTE: This card shall be placed in a conspicous place not more than 4 feet above grade on the premises on which work is to be done, and shall be maintained there until completion of such work. NOTIFY DEPARTMENT OF LAND AND RESOURCE MANAGEMENT, TELEPHONE (218) 739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED. OTTER TAIL COUNTY, MINNESOTA Board of County Commissioners cL‘»5 clvSSft A^ S o Y\S Land and H^ource Man 'a^ament Official &1. Earthmoving shall be done between 2. Entire area shall be stabilized within 10 days of the completion of any earthmoving. 3. Owner is legally responsible for all surface water drainage that may occur. 4. No fill shall enter or be taken from the beds of a public water without a valid permit from the State of Minnesota Department of Natural Resources. m^.,nUe%ri ♦ho ofwnor maw ho aiihiort---------8* JUL 12 ’93 09:13F-695 r-V5S P-001PCCUkPIt CUI IPUNtMlfai2fBWVlb2 mm r-0rp •5- y C.: j2it^jl^rlu? .cff- K-:: >V"'my5'-jc:: c><y' 7^>?&'4 mt cr J CIWe'MA 5 5=.6^yLi t / 7./i i<yVi 2iiii9-17**If ••S ■S -£2h ^fr T T1 ■Jr ;*7III3*M !•*'* )T uvkI I fc —s H@A-I133s »^2?4JL 9 Jf C3.*?irtikiSjL^§o [pi\ \\ y ¥IAt CA^k *T £’>ff P d'l -^r’CA i^*>L ^ NL 1 T -VF<£-I 2^X< 4±a.? >tI w\ X?9 ti?VV d ih ■V8 If /T /I1j# \a * =f./ p 7^ IJ-t* i flu 39^. N LAND 8i R "SOURCE OTTER TAIL COUNTY Grade & Fill Permit # 6994 PROPERTY OWNER f ^L<ari LAKE NO. HI SEC. J3 TWP. NAME /gt*3rt4 LAUb ? £>F Gl.3 £^. m.LEGAL DESCRIPTION: Fill. Pda. ^ kE^tA^ cX Bf.nTtfJCWORK ALTTHORIZED ^ fiPPuc^yiDtO — musT' FtLL^ iiJ! S t-D{ lahe / /ecPfiJ <uAfA<z ujatU- @ dA\£E iuXJiS Ml<T/t£td ~ Fil. U/THjJ ^ BAolFiU. 7^ /a^TP i)uPL£^ Fill. (5) d£.PLAi3 &Js7fJG 4' CJicATE A SuJAlc NOTE: This card shall be 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 MANAGEMENT, 218-99&«095 WHEN AUTHORIZED WORK HAS BEEN COMPLETED. 1. EARTHMOVING SHALL BE DONE BETWEEN Unjl*t & ^///H 2. Entire area shall be stabilized within 10 days of completion of any earthmoving. ■ 53. Owner is legally responsible for all 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 revoked and the owner may be subject to legal prosecution. 6- Erosion control measures must be implemented prior to anv topographical alterations. Land & Resource Management Official BK-0806-003 327.142 • Victor Lundsin Co. Pfinisrt • F«rgus FiMi. Minnosoii (B SCmED 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 SECTION TWP. NO.RANGElAKE/RIVER CLASS TWP NAME 1 f? 2/} tin (.U |^(\JKYt PARCEL NUMBER(S)rro PROPERTY (E-911) ADDRESS vm Loop LEGAL DESCRIPTION Sl '?! si 6i J f “/ tJf Tfe Last Name First Mailing AddressInitial DAYTIME Phone No. Srf-.(Aic pi _________ V'i»:7^ , MM Q>Pt~ OKOVi A 6p5] ~ Tjgoa..Property Owner Contractor Name PD Box 7\g- ?»V(, Lie.# Date Stamp R€C£IVEDNOTES: 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.LAND t resource L&R Initial PROJECT REQUEST (You may use the grid on back for required scale drawing): (\}^uPLjEA^ DESCRIBE YOUR PROJECT(S): 'J. Ttv 0 jjpfii 0 i r.'l! SanJ. '"O \)-t y i •[• />. V?' 8'!a\ \a u 1 1 7 ^ a.)oo')<. ac\d 2' (A xcV-•-.\,> V Pu w^Sv^lc. CljSh. 7 eyisttL'^ uveu hc-vCe d (vL-x^rv.;,. . 5'lc.V; prx c ^fr C^C i *‘d C'(’,30 X 53 r fj V ' » f"vj ' Cl rs f * i i;'.\ dff ■r)f ^ h'^V uJo'Vcy' pna/lC QiS stA'xAri ^0 pfpy Vbct^ ,3v-\jLn ‘^"IvyAtlUve bf\CY c.v\Uvv^~txAal'.C'w .X Aiw.i\ctiH o<'. 4p'pt'i:yv^ 1272 ivvi.v-',::-::\7.c :Vx \ DETAILED INFORMATION: AREA TO BE CUT/EXCAVATED:= VV.^Yds^C>0 Ft. X Ho Ft. X >5~ Ft. - 27 Ave. Depth Ft. - 27 = Width 3 , Lfi/VX Yds^Ft. X Ft. XWALK-OUT BASEMENT PROJECTS: (Outside of the building foundation)Length AREA TO BE FILLED/LEVELED:(i) MAa.' W Length Width Ave. Depth Ft. X Ft. - 27 = Yds' Ave. DepthV ,5-/t T 21 " TOTAL EARTHMOVING REQUESTED = HcL>. IFt. X H/) Width 2.7^\AiiU V ai 1 3H Yds' .5 Ft.BACKFILL AT FOUNDATION;Ft. Max. Depth Distance From Foundation CULVERT:If Yes, must indicate size and location on drawing. Yes No W Proposed IO‘5lL,l7k %IMPERVIOUS SURFACE:Existing % V 7 »s.r .i'J 14£iBUM3231-—- RECEIPT NUMBER Scale Drawing along with detailed impervious surface calculation must accompany this Application. 5,mOcb SIGNATURE OF PROPERTY OWNER/AGENT FOR OWNER DATE BK082013 !iIi!IIII The scale drawing must be a signed drawing which includes and identifies a graphic scale, (feet)^;^ existing an J^or proposed structures, septic.tanks,; | drainfields, jlotlines, road right-of-ways, easements, OHWLs, wells, wetiafids, topographic feature^|(i.e. bluffs); a id onsite impervious surface calcuiations.i [ I 1I ;I TiIScale!;I 1 I (i ii;:iII.1.11 T I I !!I !iI [I ;:■ i j 1tI ILCTTEXTEfOS WOrtCR tS.TT I IiII NO- or S’z' W ;:I ;Ij.-I_______ I 1 1I t1I ii QSlri;m.4rT II !i 1iII I :II1I J i-i I; ; i I zI IRElj) ©§i i 1 £I II 1 I:i i III ! EXISTIN(^ 6rARAfiE 1 I : J.__II T I C-AB(WI I Ii 1I ! I1 I ctoi Lundeen Co. PrintersBK — 0209 1-800-346-4870 352,194 • Vi Fergus Falls. MN!i IKn^iir^O^UCIION PO Box 268 98 7“* Ave NE Perham, MN 56573 Phone: 218-346-2679 Fax: 218-346-3698December 29, 2014 To: Bill Kalar From: Aridv Pettow Constructiori Re: Extending Ken & Barbara Olson’s Grade and Fill Permit #6994 Bill We will be finishing up all of the dirt work required at Ken & Barbara Olson’s on Rush Lake in the spring of 2015 (approximately April/May 2015) when the frost goes out and dries up enough to do the final grading. No other material will be brought into the building site as it is all in the place this last fall. RECEIVEDThank you, S": Matt Pettow LAND & RESOURCEAndy Pettow Construction iPGUfiOcIfiLL. IS 7Z> r}PPtiD\^'dL P)LL f pL&iii ^ @ 1 OTTER TAIL COUNTY!I i-Special Use Permit SUP No.232£; *L \j/p ^ _____________________________ /y-~/ ^l?f^x va LiOCSltlOnS Lake No.-^“/j!Sec. A5- Twp./v?5 Range-3^ Twp. Name L^Ju. /^aaJ Issued /o 19^ , Expires^i^5^ 1 Work Authorized KH kfti, Afortit__iyy*Pfr MA9\Arii aoubiiH Iftt OWNER’S NAME: Address Guh/fH- S /rf (o.L> V 4&! BY: NOTE: This card shall be placed in ^ conspicuous place not more than 4 feet above grade on the premises on which work is to be done, and shall be maintained there until completion of such work. Notify Department of Land and Resource Man^ement, Telephone (218) 7^-2271 when authorized work has been completed. ADMINI^^ATOR, Land and Resource Management OTTER TAIL COUNTY, MINNESOTA Board of County Commissioners i Entire area shall be stabilized within 10 days of the completion of the moving project. 4^. Owner is legally responsible for all surface water drainage that may occur.\ . Scale: Each grid equals ) *~feet/inches GRID PLOT PLAN SKETCHING FORM ^ 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. ff/l 19 ■Dated: S^€(.oT ^ SPcrronJ a3j ^/P3 C>F QiJc^/Oin^f/uT Ao7~S 3 Tu>P, /J5. /f, 39, ) "10 /Pl4^ (T>i X (% C«s, o\ Mi >. nG $ . I--1 t r7 U4 j __4_ . :TI___ /4 ,5^y . Ni^tfi / i■ n CO0>t^Q K yOd/---------- ^./ o <o Q c\jIN (SI 21598 7®MKL-0871-029 VICTOR LUNOCEN CO.. PRINTERS. FERGUS FALLS. MINN.