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Home My WebLink AboutSwan Lake Club_13000190112000 _ 22820_Shoreland Permits_Grade & Fill Permit #6107 AuMiKPROPERTY OWNER obIS!SEC, LEGAL DESCRIPTION; ?T CL'h.,. S LAKE NO.TWP. NAME 4/tvx. ufi “Vu l-S 0 cf (3C 4^WORK AUTHORIZED ^ t\\ \,fe4.<»J l^c c (toc .►VVo.Oofftjk. ■ i/v Cer^'Wf' *■ \t.p 1../.,^ riCrV. lAA-Cl ^ I \AAjWv<r\.\^ Cb</VC>/^W ^•o\. a/o FuVV o^vV A Nf\ l^U^T' «^f4-/irf. P~CCv^ 'Vu^ V •^wV.l._____________________________ 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, 218-998-8095 WHEN AUTHORIZED WORK HAS BEEN COMPLETED. i.v At>?4 1. EARTHMOVING SHALL BE DONE BETWEEN ^ - * (^ !o -lS-'(-/ 2. Entire area shall be stabilized within 10 days of completion of any earthmoying. 3. Owner is legally responsible for all surface water drainage that may occur. 'I ^4. No fill shall enter or be taken from the beds of public wa^er 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. 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 TWP NAMELAKE/RIVER CLASS SECTION TWP. NO.RANGELAKE/RIVER #lAKE/RIVER NAME 1^1 PROPERTY (E-911) ADDRESSPARCEL NUMBER(S) LEGAL DESCRIPTION ^^-3 /~a.Ac, DAYTIME Phone No.First Initial Mailing AddressLast Name 'tri. fJ. _______ Property Owner Contractor Name ? 3________ S3y&&Sdy/^d3^-'2 70^'- Lie,# 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. IReceived DATEL&R Official PROJECT REQUEST (You may use the grid on back for required scale drawing): 6 P /4$k.r~ y tn. 5fV?4- L^YDESCRIBE YOUR PROJECT(S): h&- t~r3>(Xr=g-a^ /Jo vsii^ 'S(Silted P~i^0~a.9-t Le~X3\^ Atr.iC ¥ DETAILED INFORMATION: AREA TO BE CUT/EXCAVATED:Yds^Ft. - 27 =Ft. X Ft. X Width Ave. DepthLength Yds^Ft. - 27 =WALK-OUT BASEMENT PROJECTS: (Outside of the building foundation) Ft. X Ft. X Ave. Depth _Ft. X Ft. X '^\ Ft. - 27= LO Yds^ Width Ave. Depth'i- 3" ^ As * TOTAL EARTHMOVING REQUESTED = Length Width 1^0AREA TO BE FILLED/LEVELED: .f.vv kh-Length L moA l ^--^Yds^ BACKFILL AT FOUNDATION:Ft.Ft. Distance From FoundationMax. Depth ill / If Yes, must indicate size and location on drawing. £2^200 r '7-^'V - CULVERT: Yes No .f)L^ %IMPERVIOUS SURFACE: <1 ( RECEIPT NUMBERDATESIGNATURE OF PROPERTY OWNER/AGENT FOR OWNER BK02/09 The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/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.'^0'/ Scale 9 e SO- t 'i I i ; ; 0. BK — 0209 336,629 • Victor Lunctoen Co.. Printers ■ Fergus Falls. * )'800-346-4870 SCALIE DRAWING FORMi-l-H H tri Ii—t 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 structures, septic tanks, drainfields, lotlines, road right-of-ways, easements, OHWLs, wells, wetlands, topographic features (i.e. bluffs), and onsite Impervious surface calculations. % Scale Impervious Surface Ratio (Must Complete Worksheet On Other Side) IT br [71.. .FI7*> T/ :4I t-... D Q p1 VaI X- di>i f l/i ri ttri (& 55 r:II % y£.ft w 00 i fi£T ♦AmJct-r>00 ✓7Pift I n AIf ■ DstGSignature of ^Proper y Owner H1BK^Co, Primers •• •• Porgus J -.1-800-24648:0.338,696..•...VCIO .Lundeen BIIS..MN T r> "- jy'' ^ - 4#% iV •/. <^ '4t-' *. t sV/ '■*, Grade & Fill Permit #ns PROPERTY OWNER I s4v-\,v^y-v LAKE NO. -5~(.-7Yl SEC. I TWP. NAME UL 3VMKy\ Kk<_ cAn-b 3: LEGAL DESCRIPTION:^ I IL of -K» \os>W*^ . pp-f 07l\ rv^v.V4A.«^ ^WORK AUTHORIZED kca, ek If dr Av <jri\V VVOVk.^ r\e>rAr^V^ O-^ V>owsJL« Fm *^\U WAqvJ ^\sV\ o \*^ T\AyL fe> -P f- C.M . /afc?. »r^tnf\ 3^0 Q 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 MAN-______ AGEMENT, 2\drn^-221\ WHEN AUTHORIZED WORK HAS BEEN COU?\^p^^^ Oj —j ^ ----- 1. EARTHMOVING SHALL BE DONE BETWEEN fO-lf-^3 i U-IS--05 ^ rxKw\*N^ \ v\ 2. Entire area shall be stabilized within 10 days of completion of any earthmoving. 3. Owner is legally responsible for all surface water drainage that may occur. 4. No fill shall enter or be 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 APPLICATION FOR GRADE & FILL PERMITfTOPOGRAPHICAL ALTERATION / IMPERVIOUS SURFACE Land & Resource Management Government Services Center, 540 West Fir, Fergus Falls, MN 56537 218-998-8095 www.co.otter-tail.mn.usOTTER Tflll c o 0 a TT< ■ I Permit No.PLEASE PRINT OR TYPE ALL INFORMATION LAKE/RIVER #LAKE/RIVER NAME LAKE/RIVER SECTION TWP. NO.RANGE TWPN/^yiE (9a/ PARCEL NUMBER(S)PROPERTY (E-911) ADDRESS /3iXO/'^0//J2oof LEGAL DESCRIPTION Last Name Initial Mailing Address DAYTIME Phone No.C_5r^;-77,1. A4 ^/itlProperty Owner h^oerH (2su^i\fTContractor Name Pit '770-/7?J7>/ Ce> ^ Pf3S(p ^p-f:Lie. #f NOTES: 1. A Scale Drawing & Impervious Surface Worksheet must be included with this Application. 2. The lotlines and project area(s) must be identified & staked onsite. 3. If project disturbs more than 1 acre of land, you must obtain a General Storm Water Permit from the MPCA. Date Stamp L&R Initial 0f /DESCRIBE YOUR PROJECT(S): r ff I C» TOPOGRAPHICAL ALTERATION: AREA TO BE CUT/EXCAVATED:Yds^Ft. X Ft. X Ft. - 27 = Length Width Ave. Depth Yds^WALK-OUT BASEfulENT PROJECTS: (Outside of the building foundation) Ft. X Ft. X Ft. - 27 = Length Width Ave. Depth Yds'AREA TO BE FILLED/LEVELED:Ft. X Ft. X Ft. - 27 = Width Ave. DepthLength Yds'TOTAL EARTHMOVING REQUESTED BACKFILL AT FOUNDATION;Ft.Ft. Max. Depth Distance From Foundation CULVERT:If Yes, must indicate size and iocation on drawing. Yes No IMPERVIOUS SURFACE BUILDING: Existing IMPERVIOUS SURFACE TOTAL: Existing %Proposed Proposed % %% r Receipt NumberDateIgnature Of Property Owner/Agent For Owner BK04-2014 354,253 • Victor Lundeen Co. Printeis • Fergus Falls, MN • l-flOO-346-4870 The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/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. X / Scale 5 '"■V- c p,-rr.-r GRADE & FILL APPLICATION « COUNTY OF OTTER TAIL - LAND & RESOURCE MANAGEMENT 121 W JUNIUS SUITE 130, FERGUS FALLS, MN 56537 218-998-8095 Otter Tail County’s Website: www.co.ottertail.mn.us PERMIT NO. 3 O Application Fee tin'llReceipt Number PROPERTY OWNER dung . pv/e, ^ m. 9 r(g» MAILING ADDRESS :;ia82o r/- Tkj-___________________ CITY, STATE, ZIP DAYTIME PHONE NUMBER LAKE NO. '7$!CLASS K bLAKE NAME WA<v) PARCEL NUMBER(S) K Ho 11-Z. Q^) SECTION iA LEGAL DESCRIPTION 3 LA^e r^o,.) TWP NAME VAtvS PeAl>^>e E-911 PROPERTY ADDRESS SIGNATURE OR PROPERt/oWNER/AGENT FOR OWNER 0<&-. 2.3.2^3 DATE ?-■■—» j,'' i DATEL&R Official DESCRIPTION PROJECT REQUEST BELOW (Provide Scale Drawing On Back) TOTAL CUBIC YARDS .^00 ts» (oO OLjj ^ (a/<^vvv“\' "Vx) jlurWt/y- hlc^cJU:h^. o^rU<_ lvt^vv6>,t- - 4p le^eX. c?j^ ^wt Ohj‘^. Ue^fg-rLj ^vm^u tiXvr>s-Tr- jUn^s-^ t'ar^ IXa ^ Jo ^4a3-vt^ yo A^J)^).cuL1Z ^T^g-ns/'crn. .j-f' ^ry b. VJ-.- . £>!/£> criu^lc^ BK05/00 311,493 • Victor Lundeen Co., Printers • Fergus Falls. MN • 1*800-346-4870 ffcfetinch(es) equalsScale:,grid(s) equals feet, or Please use this sheet for the required scale drawing of your proposal. Be sure to include lot dimension, water frontage, and setbacks from RW, lake, lot lines, sewage system, top of bluff, existing structures and all imper- Required impervious surface coverage calculation (See definition in Shoreland Management Ordinance) X 100S70CiV3 % Total Lot Area (FT2) Total Impervious Surface Onsite (FT2) y / f /T«< ■ IIX I I I >rf X'>i X. ' vsIc 3o I 'i "'S? -) V ! r '1<L-i : r L(;»\‘ ' AM0 ^ !:? (! C -«a ] s ! IVI■ X : c \ o ^\\ijCL KVi ; K i /t-. - O V Q . Q^f rf>.f g ■ O' ■&■L'- o r: C d>y p .rr-r/~0 tp r>y Signature .Dated BK — 0500 — 029 V ^^^^nesota If MINNESOTA DEPARTMENT OF NATURAL RESOURCES Permit Number Public Waters Work Permit Expiration Date: 11/12/2019 2015-0702 OEPWilNEIfTOf NAnilUL RESOURCES Pursuant to Minnesota Statutes, Chapter 103G, and on the basis of statements and information contained in the permit application, letters, maps, and plans submitted by the applicant and other supporting data, all of which are made part hereof by reference, PERMISSION IS HEREBY GRANTED to the applicant to perform actions as authorized below. Project Name:County: Otter Tail Watershed: Pomme de Terre River Resource: Lake: Swan (56078100)Judy Stringer Purpose of Permit:Authorized Action: Riprap (Natural Rock)Permittee is authorized to riprap up to 230 feet of shoreline. Riprap shall consist of natural clean rock averaging between 6 and 30 inches in diameter. Riprap shall follow the existing alignment of the shore and be installed at a 3:1 (horizontal to vertical) slope. The rock shall not extend more than 9 feet waterward of the toe of the existing lake bank and may be underlain with geotextile fabric.________________________ Permittee:Authorized Agent: STRINGER JUDY 22820 N SWAN LAKE TRL FERGUS FALLS, MN 56537 (218) 739-7214 N/A Property Description {land owned or leased or where work will be conducted): UTM zone 15N, 267672m east, 5124311m north, Meandered water body of Section 19, T132N, R42W Authorized Issuer: Julie Aadland Title:Effective Date: 11/12/2014 Issued Date: 11/12/2014 Expiration Date: 11/12/2019Area Hydrologist This permit is granted subject to the following CONDITIONS: APPLICABLE FEDERAL, STATE, OR LOCAL REGULATIONS: The permittee is not released from any rules, regulations, requirements, or standards of any applicable federal, state, or local agencies; including, but not limited to, the U.S. Army Corps of Engineers, Board of Water and Soil Resources, MN Pollution Control Agency, watershed districts, water management organizations, county, city and township zoning, NOT ASSIGNABLE: This permit is not assignable by the permittee except with the written consent of the Commissioner of Natural Resources. NO CHANGES: The permittee shall make no changes, without written permission or amendment previously obtained from the Commissioner of Natural Resources, in the dimensions, capacity or location of any items of work authorized hereunder. SITE ACCESS: The permittee shall grant access to the site at all reasonable times during and after construction to authorized representatives of the Commissioner of Natural Resources for inspection of the work authorized hereunder. TERMINATION: This permit may be terminated by the Commissioner of Natural Resources at any time deemed necessary for the conservation of water resources of the state, or in the interest of public health and welfare, or for violation of any of the conditions or applicable laws, unless othenwise provided in the permit. COMPLETION DATE: Construction work authorized under this permit shall be completed on or before the date specified above. The permittee may request an extension of the time to complete the project by submitting a written request, stating the reason thereof, to the Commissioner of Natural Resources. (K/IPARS revision 10/07/2013, Permit Issuance ID 13722, printed 11/13/2014)CONDITIONS continued on next page. CONDITIONS (Continued from previous page) WRITTEN CONSENT: In all cases where the permittee by performing the work authorized by this permit shall involve the taking, using, or damaging of any property rights or interests of any other person or persons, or of any publicly owned lands or improvements thereon or interests therein, the permittee, before proceeding, shall obtain the written consent of all persons, agencies, or authorities concerned, and shall acquire all property, rights, and interests needed for the work, PERMISSIVE ONLY / NO LIABILITY: This permit is permissive only. No liability shall be imposed by the State of Minnesota or any of its officers, agents or employees, officially or personally, on account of the granting hereof or on account of any damage to any person or property resulting from any act or omission of the permittee or any of its agents, employees, or contractors. This permit shall not be construed as estopping or limiting any legal claims or right of action of any person other than the state against the permittee, its agents, employees, or contractors, for any damage or injury resulting from any such act or omission, or as estopping or limiting any legal claim or right of action of the state against the permittee, its agents, employees, or contractors for violation of or failure to comply with the permit or applicable conditions. EXTENSION OF PUBLIC WATERS: Any extension of the surface of public waters from work authorized by this permit shall become public waters and left open and unobstructed for use by the public. WETLAND CONSERVATION ACT: Where the work authorized by this permit involves the draining or filling of wetlands not subject to DNR regulations, the permittee shall not initiate any work under this permit until the permittee has obtained official approval from the responsible local government unit as required by the Minnesota Wetland Conservation Act. CONTRACTOR RESPONSIBILITY: The permittee shall ensure the contractor has received and thoroughly understands all conditions of this permit. Contractors must obtain a signed statement from the property owner stating that permits required for work have been obtained or that a permit is not required, and mail a copy of the statement to the regional DNR Enforcement office where the proposed work is located. The Landowner Statement and Contractor Responsibility Form can be found at: http://www.bwsr.state.mn.us/wetlands/wca/index.html#general. INVASIVE SPECIES - EQUIPMENT DECONTAMINATION: All equipment intended for use at a project site must be free of prohibited invasive species and aquatic plants prior to being transported into or within the state and placed into state waters. All equipment used in designated infested waters, shall be inspected by the Permittee or their authorized agent and adequately decontaminated prior to being transported from the worksite. The DNR is available to train inspectors and/or assist in these inspections. For more information refer to the "Best Practices for Preventing the Spread of Aquatic Invasive Species" at http://files.dnr.state.mn.us/publications/ewr/invasives/ais/bestjDractices_for_prevention_ais.pdf. Contact your regional Invasive Species Specialist for assistance at www.mndnr.gov/invasives/contacts.html. A list of designated infested waters is available at http://files.dnr.state.mn.us/eco/invasives/infested_waters.pdf. A list of prohibited invasive species is available at www.mndnr.gov/eco/invasives/laws.html#prohibited. EROSION AND SEDIMENT CONTROL: In all cases, methods that have been determined to be the most effective and practical means of preventing or reducing sediment from leaving the worksite shall be installed in areas that slope to the water and on worksite areas that have the potential for direct discharge due to pumping or draining of areas from within the worksite (e.g., cofferdams, temporary ponds, stormwater inlets). These methods, such as mulches, erosion control blankets, temporary coverings, silt fence, silt curtains or barriers, vegetation preservation, redundant methods, isolation of flow, or other engineering practices, shall be installed concurrently or within 24 hours after the start of the project, and will be maintained for the duration of the project in order to prevent sediment from leaving the worksite. DNR requirements may be waived in writing by the authorized DNR staff based on site conditions, expected weather conditions, or project completion timelines. FISHERY PROTECTION - EXCLUSION DATES: No activity affecting the bed of the protected water may be conducted between April 1 and June 30, to minimize impacts on fish spawning and migration. If work during this time is essential, it shall be done only upon written approval of the Area Fisheries Manager. See contact list at: http://files.dnr.state.mn.us/fisheries/management/dnr_fisheries_managers.pdf. Should work begin elsewhere in the project area within these dates, all exposed soils that are within 200 feet of Public Waters and drain to those waters must complete erosion control measures within 24 hours of its disturbance to prevent sediment from entering Public Waters. MAINTENANCE: Maintenance of this project to originally authorized conditions may be authorized by amendment to this permit. BUFFER STRIP: Buffer strips are encouraged. A strip of native perennial vegetation planted along the shoreline reduces erosion, adds beauty, benefits water quality and provides habitat. Resources and information are available @ CONDITIONS coiitinusd on next page...Page 2 - Permit Number 2015-0702 1 •CONDITIONS (Conf/nued from prewous page) http://www.dnr.state.mn.us/restoreyourshore/in/index.html. The East Otter Tail Soil and Water Conservation District's Lakeshore Specialist is also available to assist in planning and planting a native buffer. He can be reached at . 218-346-4260. cc: Jacobs, Mark, Agent Troy Richards, Conservation Officers, Fergus Falls i 1 ^ i /. ; •j li •I ; ■i- ■■ .:i'r.' ■ 'i ; ; '. Page 3 - Permit Number 2015-0702 'j ■! • -1 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT WHITE - Office GOLDENROD —Inspector YELL&W - Owner PINK — Assessor i^OUO ' I'j-O 111-- oOl 7-0 J3Z: _ia Lake Classif. Sec. TWP R^nge Permit No..LEGAL I r i/MDESCRIPTION AND LOCATION Pra ISsi-lll 6iA/aK) TWP NameLake No.Lake Name lOENTtFICATION; Ptease Print AH Information Tel. No.First Zip No.Initial Mailing Address— No. Street. City and State K>y- H:SS Last Name 3-K i Ay r. 7kP^/SOwner At 7f(K/p3^i cZ NameContractor Architect Name. NON-RESIDENTIAL PROPOSED USE;TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE: ( ) One Family Dwelling ( ) Multiple Dwelling Specify:.( ) New Building ( ) Alteration Units ( ) Other ( ) Other Size ESTIMATED COST OF IMPROVEMENT $ DIMENSIONS:TYPE OF SEWAGE DISPOSAL;PRINCIPAL TYPE OF FRAME: (l-T-Tlo^ ( ) Maspnry (OrWood Frame ( ) Structural Steel ( I Other — Specify Basement: ( ) Yes Stories above basement: Sq. feet (outside dimension) Bedroorhs ( ) Public ((>Kfndividual Septic Tank, WATER SUPPLY: etc. iJlZ-Baths.( ) ^ic ' ('-rl^ividual Well CHARACTERISTICS: feet.Water frontage is iximum depth of lot feet.square feet.Lot Area is m feerL (Building Line)Building set back from high water mark is. Land height above high water mark at building line is Building set back from^ate highway right Qf WSy..... Side yard is ............................. and.............J.Stf..... Structure will be located................./..L/___ feet ,c2e5.£X)..•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).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 ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project. Dated. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is gra;/ted 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 revoked at any time upon violation of said ordinances. £>Dated Shoreland M^agemdTTT Official Permit Fee $.Receipt No. Comments:f ^ \)> \ M\ fn ke ct ____________________________________________________ Form No. MKL-0286-019 229971® VICTOR LUNOEEN CO.. PRINTERS. FERGUS FALLS. MINN. ’ ..•'r O.lC ^ ^ p a ySHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT WHITE - Office GOLDENROD — "inspector YELLOW - Owner PINK — Assessor A ri'O iii^- ^oj f ta I /I-6 !Permit No,. I K tAi ' ^LEGAL DESCRIPTION AND LOCATION Lake Claaalf. Sec. %-lll oiwon /-“Z. J/--)£Z I \ r I ]A^_^ it TWP NameTWPRangeLake NameLake No.I IDENTIFICATION: Please Print All Information Zip No.Tel. No,Mailing Address— No. Street. City and StateInitialFirstLast Name U) > Y s:TliOwner jnTf(' / fzQvf'. ii IT 7g/SNameContractor Architect Name. NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT: Specify:.( ) One Family Dwelling ( ) Multiple Dwelling ( ) New Building ( ) Alteration Units ( ) Other Size( ) Other ESTIMATED COST OF IMPROVEMENT $ DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME: Basement; ( ) Yes ( Stories above basement: Sq. feet (outside dimension) Bedrooms ............................. ( ) Public ( cT' tndividual Septic Tank, etc. WATER SUPPLY: ( ) Public ('-rindividual Well ( ) Masonry ( \XW)ood Frame ( ) Structural Steel ( ) Other — Specify i Baths CHARACTERISTICS: feet...............feetj__ -Maximum depth of lot feefT (Building Line)^^^^^^y^ ......^....::::;;;.:::;feet' Water frontage is ..m. square feet. Building set back from high water mark is. Lot Area is Land height above high water mark at building line is Building set back from State highway right of way.... /■ ' /( IJ..;,,....... and............................ 2e:>.sv.;...feet.feet — from road right of way is feet.Side yard is /'l .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). Structure will be located 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 ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project. h ^ //4dJj.VDated.7 Signature of Owner I Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is graqted 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. ■O' •LI II'.y)Dated Shoreland ManagemehT OfficialiogPermit Fee $.Receipt No. Comments: in ke I> 7)0 Form No. MKL-0286-019 229971@ VICTOR LONDCEN CO.. PRINTERS. FERGUS FALLS. MINN. >■ V* INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS i MINIMUM Shall Be 4-Sq. Ft, Lot Area (Square feet)Sq. Ft.Sq. Ft. /J'OWater Frontage Ft.Ft. y o oBuilding Set Back from High Water Mark Ft.Ft. Building Set Back from State Highway Ft.50 Ft. 2^ -40 Ft.Building Set Back from Street or Road Ft. y ^ & / O Ft.& / ^ Ft.Side Yard Rear Yard Ft.Ft. ?Occupied Building to Septic Tank Ft.10 Ft. i?fOccupied Building to Absorption System Ft.20 Ft. Elevation at Building Line above High Water Mark_____________/•iJFt.3 Ft. Inspector's Comments: '7 Inspector's sjgnature Title Inspection Dated / L'19 f/ Agency VICTOR LUNOfCH C M.. OtIRTCM. fCMUO r«U.O, \ ! Each grid equals f ^ /.w.-*^-^feet/inchesScale.GRID PLOT PLAN SKETCHING FORM V.(fa 19*^0 ^j_Ai<*C -7^ Dated Signature Please sketch your lot indicating setbacks from road right-of-way, lake and sideyardlor each building currenfly on lot and any proposed structures. ■T /?: .;JL4. 0^^ 6> r‘ t I ¥/ 1 iI-J r -I. r -l X i I I I i 11^'[- }■j ‘P j r-\% 4. I , -4 \ V r1—r ^,-4—!1-^ •X 14- t I ■t T IX------- tTT J 'IX. 77 // if 21598 7®MKL-0871-029 VICTOK LUNOCCM CO . PRINTERS. FERCUS FALLS.