HomeMy WebLinkAboutSunrise Resort_14000250201000_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.
TWP NAMETWP NO.RANGELAKE/RIVER
CLASS
SECTIONLAKE / RIVER NO.LAKE/RIVER NAME
astoe
PROPERTY (E-911) ADDRESS
g.\C.W\J \<-L-^
PARCEL NUMBER (S)
YTtfO___+LEGAL DESCRIPTION
I ^ ^ U3 C\o.qEftc^
Daytime Phone No.Mailing AddressFirst InitialLast Name
PO. ____________
Pi u g Cs
'Til ~'o8oS~'§S 1^Property
Owner
Contractor **
Name
Lie.#
SgL^ CLcmgACr c
hxi!^PROPOSED PROJECT (please circle the appropriate number)
( 2 ) Add'n to Dweiiing
(5) RCU/Year_____
{8) Storage Structure
ONSITE SEWAGE
TREATMENT SYSTEM
( ) L&R Cert, of Compliance
( ) Compliance Inspection Report within 3 yrs. (Attached)
( ) OTWMD ‘Must have Sewage System Approval
from OTWMD prior to issuing Site Permit.
Contact Roltie Mann at 218-864-5533
ONSITE WATER SUPPLY
h^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
(1 ) New Dwelling
( 4 ) MH/YR
( 7) Add'n To Non-Dwelling
^(TOT^on-Conf. Replacement (identify)"
(11) Other (identify)________________________^
(12 ) Deck________________________________
(13) Fence_______________________________
(9)W.0A&AWcLtjt
"Existing Non-Conf. Structure Verified by L&R‘Removal of Existing Dwelling Verified by L&R
Inspector’s Initial/DateInspector's Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
Dimension
•^CHARACTERISTICS OF PROPOSED DWELLING
'‘7T (Must Include Attached Garage)
Outside Dimension Ft. x ^ FI."
Sq. Ft \
Setback to Lotline _
Setback to Right of Way Ft.’*
Setback to Ordinary High Water Level Ft.
Elevation Above Ordinary High Water Level 2^
»-t^Ft
Ft. X Ft."Ft.”Ft. X
Sq. Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank___
Setback to Drainfield____
Setback to Bluff________
Maximum Proposed Height
Roof Change ( ) Yes ( ) No
Bathroom Proposed ( ) Yes ( ) No
SGtopt. &Sq. Ft.
Setback to Lotline ____
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank___
Setback to Drainfield____
Setback to Bluff________
Maximum Proposed Height
Ft.”Ft."Ft.&Ft.**Ft.&
Ft.**Ft.**
Ft.Ft.
Ft.Setback to Septic Tank
Setback to Drainfield ^S^Ft.
Setback to Bluff Ft.
Total Bedrooms
Maximum Proposed Height Ft.
Ft.
Ft.Ft.
Ft.Ft.
Ft.Ft.
Ft.Ft.Roof Change ( ) Yes No
Basement ( ) Yes No
Walkout Basement ( ) Yes (side profiie required) ^^No
( ) Screen Porch
( ) Storage Structure
( ) Boathouse
( ) Gazebo
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
Topographical Alteration / Earthmoving
□ None 8 20 Cubic Yards or Less * □ 21 Cubic Yards - 999 Cubic Yards*
* Must Include on scale drawing,
additional Permit may be required.□ 1,000 Cubic Yards or More*
Lot AreJ*r\ \ ^ t \Yes ( ) NoCHARACTERISTICS OF LOT:Ft.BluffSq. Ft.Water Frontage
£U^
Impervious Sur1«e Ratio
.%.%
Building 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^nd & Resource Management office once the building footings have been constructed.
Date: ^ ~ ------
Signatory of Property Owner / Agpnt for Owner
Date:L^I^^R^oi^Management OQi^
/M,')RECEIPT NO.PERMIT FEE $PROJECT(S) TOTAL SQ. FT.
Date StampComments:
. .1—v-l'
L&R Initial
Form No. BK — 08-015-2013 352.196 • Victor Lundeen Co., Printors • Fergus Falls. Minnesota
(OE-
WHITE - Office
GOdDENROD - Inspector •
YELLOW - Owner (after issue)
PINK - Assessor
APPLICATION FOR SITE PERMIT
o!^LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 7) 2>ecti OtC.218-998-8095
www.co.otter-tail.mn.us
mON Must BE COMPLETED IN ORDER TO BE PROCESSED.
■')
Permit No.APPLICA
!]LAKE / RIVER NO.SECTION TWP NO.RANGE TWP NAMELAKE/RIVER NAME LAKE/RIVER
CLASS
SO<\)f.
'. I
PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS
U^VWJ\^L;
T ■; \vj
I >■' i ' -') ' ^
A I"'03^5 \'V».+LEGAL DESCRIPTION
G-*' i :■-O kL.L- >< X.
Daytime Phone No.Last Name First initiai Mailing Address
ItiProperty
Owner 'm- in A 1 i <
0 A \) I-. ( ^
i
cf.t i~.
Contractor
Name
Lie.#
('■
i
1f'hjL- hi4h.PROPOSED PROJECT (please circle the appropriate number)ONSITE WATER SUPPLY ONSITE SEWAGE
TREATMENT SYSTEM 5^individuai ( ) Pubiic ( ) None
'NO^E: mn Ruies Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
( ) L&R Cert, of Compliance within 5 yrs-. *'■ - «
(2 ) Add'n to Dwelling
(5 ) RCUTTear
>/ ( 7 ) Add'n To Non-Dwelling (8 ) Storage Structure
^'(^O^on-Conf. Replacement (identify)"
L rTTfOther (identiM ______________^
(3) Replacement Dwelling*
(6) Attached / Detached Garage
(9) W.O.A.S
(1 ) New Dwelling
(4) MH/YR____
( ) 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
<£eC<ZLyDeck
13) Fence.
•Removal of Existing Dwellii^S Verified by L&R ’•Existing Non-Conf. Structure Verified by L&R
Inspector's Initial/DateInspector's Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
Outside Dimension ^
Sq. Ft. I
Setback to Lotline
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
Dimension Ft. X Ft."Ft. X__li Ft.**Ft. X Ft."
Sq. Ft.
Setback to Lotline____
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank___
Setback to Drainfield ____
Setback to Bluff________
Maximum Proposed Height
Roof Change ( ) Yes ( ) No
Bathroom Proposed ( ) Yes ( ) No
Sq.Ft.
Setback to Lotline _______
Setback to Right of Way ^^
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff________
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft.**Ft.&Ft.**
fFt.&Ft.**Setback to Right of Way ^ Ft.**
Setback to Ordinary High Water Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield
■>Ft.**i L=0.n.Ft.**
Ft.Ft.
Ft.Uf ' Ft.
'-.5^7*^ Ft.
j >*v Ft.
Ft.
Ft.Ft.
Setback to Bluff
Total Bedrooms
Maximum Proposed Height
Roof Change ( ) Yes (^) No
Basement ( ) Yes (>^) No
Walkout Basement ( ) Yes (side profile required) (^-) No
Ft.Ft.
, -k Ft.Ft.^ Ft.'4Ft.nFt.I
( ) Screen Porch
( ) Storage Structure
Topographical Alteration / Earthmovinq
□ None
* Must include on scale drawing,
additional Permit may be required.□ 21 Cubic Yards - 999 Cubic Yards*□ 1,000 Cubic Yards or More*□ 20 Cubic Yards or Less *
CHARACTERISTICS OF LOT:Sq. Ft.Bluff ( -') Yes ( )NoLot Area- f Water Frontage Ft.
i.%.%1
1Building Surface Ratio Impervious Surface Ratio I
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 building footings have been constructed.
Date:
ii
i
i
3
i
1Signature of Property Owner / Agpnt for O
Lahd% Resource Management Ofpeldi
wner 5•j
9-19-13 1Date:
PERMIT FEE $PROJECT(S) TOTAL SQ. FT.,RECEIPT NO.
Comments:
!
^B5SIForm No. BK — 08-015-2013 352,196 • Victor Lundoon Co., Printers • Fergus Falls, Minnesota
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
|4|| (\Jor\- Cert'll
/Vt(^ U''\>U/L Q^ci:x{
5^' Ft./Structure Set Back from Ordinary High Water Level Ft.Oir
Structure Set Back from Top of Bluff Ft.Ft.
lOO^)6« Ft.)Oo^/60’'Structure Set Back from Road Right of Way Ft.
Ft.& lOj^MStructure Set Back from Lot Lines Ft.
M‘y~-L Ft.Structure Height Ft.^ -
/O^10^jc^10 ^ Ft.Structure Set Back from Septic Tank Ft.
ao Ft.Structure Set Back from Drainfield 6 *Ft.
Elevation Of Lowest Floor Above Ordinary
High Water Level 2.'^w y y Ft.3^•t.
Land Slope at Building Site % %
- Ca>Inspector’s Comments / Sketch: ^r I t-
]?/. ioil
06 I
6$
j{
<2
6^'
frwpector's Si
b-S/3
Date of Inspeifion
Time of Inspection
ll^yi‘1 ffyfProject Approved,
Date / Initial
:
‘i SCALE DRAWING FORM
I
Tax Parcel Number(s)
The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/or proposed struotures, septic
tanks, drainfields, lotlines, road right-of-ways, easements, OHWLs, wells, wetlands, topographic features (I.e. bluffs), and onsite impervious surface
calculations.
3 (o3too*%
Scale Impervious Surface Ratio
(Must Complete Worksheet On Other Side)
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4DateSignature of Property Owner
BK — 0909 338,596 ■ Victo^ Lundaen Co. Printers » Fergus IfaUs, MN * 1-800-346-4870Ii
IMPERVIOUS SURFACE CALCULATION WORKSHEET:
List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scale drawing):
^ HO Ft2Structure(s):
Ft2Deck(s):
~H ,o 5H.Ft2Driveway(s):
Ft2Patio(s);
Ft2Sidewalk(s):
^ Q Ft2Stairway(s):
Ft2Retaining Wall(s):
Ft2Landscaping:
(Plastic Barrier)
Other:Q. R2
Ft2TOTAL IMPERVIOUS SURFACE:
MHO, in Ft2LOT AREA:
^ r H y I '^j4= X100 =.%
IMPERVIOUS SURFACE RATIOLOT AREATOTAL IMPERVIOUS SURFACE
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IMPERVIOUS SURFACE CALCULATION WORKEHEET
EXISTING Onsite Impervious Surface
Building Impervious Surface Calculation - Not to|Exceed 20%
Building(s) - Total Square Footage
Lot Area
fF
fF
X 100 =%
Building Area Lot Area Building Surface Ratio
EXISTING Lot Area Covered By Building(s)%
Total Impervious Surface Calculation - Not to Exceed'25%
^5^5 Ft^
^F
i_iBuilding(s)
Deck(s)
TPatio(s)
fFSidewalk(s)
Stairway(s)
Landing(s)fF
Driveway(s)
Retaining WaH(^
fFLandscaping (Plastic Barrier)
Other 0 : (i Ft"
\l Ft"
H I fF
Total Impervious Surface
Lot Area
\ \ F \\\ QtnI’-j
Total Impervious Surface Lbt'A"—
X100= o<%
Impe vious Surface Ratiorea
%EXISTING Lot Area Covered By Impervious Surface
PROPOSED Onsite Impervious Surface
Building Impervious Surface Calculation - Not to Exceed 20%
Building(s) - Total Square Footage
Lot Area
Fr
fF
X 100 =%
Builc^g Area Lot Area Building Surface Ratio
PROPOSED Lot Area Covered By^uijding(s)%
___Total Irnpervious Surface Calculation - Not to Exceed 25%
Building(s), SWO FP
Deck(s)
fF^tio(s)___
Sidewalk(s)fF
FtStairway(s)
Landing(s)
Driveway(s)
FrFt^
FfRetaining Wall(s)
Landscaping (Plastic Barrier)
Other
Ft
fF'n
fFTotal Impervious Surface
fFLot Area
= , ^ Q T’ -fX 100 =
Impervious Surface RatioTotal Impervious Surface Lot Area
PROPOSED Lot Area Covered By Impervious Surface
PROPOSED CHANGE IN IMPERVIOUS SURFACE : •VS %
^SCANNED
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Impervious Surface Calculation Workslieel 08-07*2013
OTTER TAIL COUNTY
Grade & Fill Permit # 6862
PROPERTY OWNER yv>.
TWP. NAMELAKE N0._^X*j:^V3 SEC,
G(, n fo TLEGAL DESCRIPTION:
WORK AUTHORIZED
Ar*» <||>tjv
^*vyAr ‘'s.v- *201H »
, Fvvv ^^^>vvv Xv<»p
««»\w ^'s,V.^. ^yco.. Vro Vx>p VJV^W
CVr«r\«-vO
r^^^V 30—v*o v-a'vVW
x,y S «-<VJ -
Cja v\Vt*«.^.V^ v~*
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,
218-998^095 WHEN AUTHORIZED WORK HAS BEEN COMPLETED.
1. EARTHMOVING SHALL BE DONE BETWEEN & O-t-iMU-C.^13
2. Entire area shall b^ 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 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.
R. Frosion control measures must be imolemented prior to any topographical alterations.
APPLICATION FOR GRADE & FILL PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR. FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
LAKE/RIVER #LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP. NO.RANGE TWP NAME
PARCEL NUMBER(S)
- CCO .2 ^ -c:?v/ - OOP
PROPERTY (E-911) ADDRESS,-. .
>7/^ X sLEGAL DESCRIPTION
f-y a/ of RO y ^
Last Name First Initial Mailing Address DAYTIME Phone No.
7?^ ^ ^ v S'/'yO/- 2^ >ST'Property
Owner
1’ 0 y?y- //^p/r-Contractor
Name // ~
yy/-y333>7^Lie.#; Vz
Date Stamp
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):
?/ //^ Ao,
^S~X/o'
DESCRIBE YOUR PROJECT(S):
"i~r.' f?
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^-t U-Tc‘L/^nr\ <?.
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/pL /// A/
7Z^/~c<c,/ej,
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Pd ca
K
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y.J- /?' ro A C'
-io P;//
DETAILED INFORMATION:
AREA TO BE CUT/EXCAVATED:Yds^Ft. X Ft. ^27 =Ft. X
Length Width Ave. Depth
Yds^WALK-OUT BASEMENT PROJECTS:Ft. XFt. X Ft. -27 =
(Outside of the building foundation)Lengthy ,
.So Ft. X
Ave. Depth
Ao Ft. X 7 ' - 27= Yds^
Width
TOTAL EARTHMOVING REQUESTED = /OA Yds^
Width. 30'
AREA TO BE FILLED/LEVELED:
Length
ZJ
Ave. Depth
BACKFILL AT FOUNDATION:Ft.Ft.
Max. Depth Distance From Foundation
CULVERT:If Yes, must indicate size and iocation on drawing.
' ; ' i. V - V ; ' -Ni: —Yes No
IMPERVIOUS SURFACE:%
1
\ an
dAte RECEIPT NUMBERiNERf AGENT FOR OWNERS1GNATUR1ROPJ
37BK062011
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lund«en Co. Prlntdr$ • Fetgus
.;.;..._!• fSignature of Proper^ Owner ;.!BK — 0909 338.596 • ^tc lalliMN • 1-800346^870
i
special Use Permit SUP No.H5J1 11 •! ^
OWNER'S i^MF- HtiAty__
^It JLAK*. tollLiOCatlOni lake^^JI^ Seilt£_Twp.t^- Rangg^O M Name LAf^
11 Ac 'hr tu y - $uMri‘t< ^tfs^irT
toN MNAddress
Issued4^$__191^ , Expires 1^*/ 19^^
H /*
ito Uv j Ar<A Clt/nl^ 4|(|A< fwf______
0^ 4»tr liAfUTtiiAHtt. !^^rf0t€t
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BY:
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, 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.
ADMINlWRATOR, Land and Resource Management
^ 4 OTTER TAIL COUNTY, MINNESOTA
Board of County Commissionersr\i
;
iI
1. Entire area shall be stabilized within 10 days of the completion of the moving project..
2. Owner is legally responsible for all surface water drainage that may occur.
3. No fill shall enter or be taken from the beds of a public water without a valid permit from the State of Minnesota Depart-i I
HILARY D BARRY BOX 98LAKE WILSON,MN 56151
R e C ET, J V E
J'JN 0 f 1990
land & RESOURCE
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