The URL can be used to link to this page

Home My WebLink AboutVacationland Resort_25000020011002_Shoreland Permits_WHITE-Office GOLDENROD - Inspector YELLOW - Owner (after issue) APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.usOTTER milcoiaTT-aiiiiioTi Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. LAKE / RIVER NO.LAKE/RIVER NAME SECTIONLAKE/RIVER TWP NO.RANGE TWP NAMEC Wl 0^0 PARCEL NUMBER (S) — ~^^0’— o0>0\^ ^OoO - CoO - — oQ?o^\ - OOP LEGAL DESCRIPTION PROPERTY (E-911) ADDRESS ^sijT DEVELOPED'P-P feta. ^•g.e-T- Ufr. It 2 UNDEVELOPED Last Name First Initial Mailing Address Daytime Phone No. A-AC/si IZA}t~Z.€S)ct SProperty Owner Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) (1) New Dweiiing ( 2) Add’n to Dwelling/Attached Garage ( 3) Replacement Dwelling* (4) MH/YR________ ( 5) RCU/Year________ r ( 6 ) Detached Garage ( 7) Add'n To Non-Dwelling (8) Storage Structure ^ -t*L (9)'^0-A.S. #?fC75^ri-Conf. Replacement (identify)" LAnjFT3 ~ 4cC.4-"nb*^ (11'tother lidentiM Deck Fence ONSITE WATER SUPPLY (^Individual ( ) Public ( ) None NOTE: MN Ruies Chpt. 4725 (MN Weli Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ( ) L&R Cert, of Compliance within 5 yrs. ( ) Compliance Inspection Report within 3 yrs. (Attached) OTWMD ‘Must have Sewage System Approval f from OTWMD prior to issuing Site Permit. Contact Rollie Mann at 218-864-5533 ( ) New Septic Permit Issued Permit #© •Removal of Existing Dwelling Verified by L&R________ CHARACTERISTICS OF PROPOSED DWELLINO (Must Include Attached Garage) Outside Dimension Ft. x XCo Ft.** Sq. Ft. 53P Setback to Lotline Setback to Right of Way V~t \ Ft.** Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level ^ Setback to Septic Tank ^ Ft. Setback to Drainfield Ft. Setback to Bluff fOA Ft. Total Bedrooms ^ Maximum Proposed Height Ft. Roof Change (^ ) Yes ( ) No Basement ( )Yes ('/iNo Walkout Basement ( ) Yes (side profile required) (^) No ••Existing Non-Conf. Structure Verified by L&R Inspectors tnilial/Oale Inspector's Initial/Dale CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension Ft. X Ft.** Ft. X Ft.** Sq. Ft. Setback to Lotline \ Setback to Right of Way Setback to Ordinary High Wat^kl^el __ Elevation Above Ordinary High/W^r Level Setback to Septic Tank > Setback to Drainfield / Setback to Bluff / Maximum Proposed Height Roof Change ( ) Yes ( ) No Bathroom Proposed ( ) Yes ( ) No FL&Sq. Ft.________ Setback to Lotline ___ Setback to Right of Way Setback to Ordinary High Wat^Level Elevation Above Ordinaryffigh wS(et Level Setback to Septic Ta Setback to Drainfl/d Setback to Bluff________ Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / inspection Ft.**Ft.&Ft.**Ft.&Ft.”'1^■t.** Ft.” Ft.Ft.Ft. Ft. ■L Ft.Ft. Ft.Ft. Ft.Ft. ( ) Screen Porch ( ) Storage Structure Topographical Alteration / Earthmoving ^ LAI^ 20 Cubic Yards or Less * CHARACTERISTICS OF LOT: * Must include on scale drawing, additional Permit may be required.□ None □ 21 Cubic Yards - non r.nhir VarHc*□ 1,000 Cubic Yards or More* ( )Yes ()(fNo KJCM Impervious Surface Ratio ""O Ft.Bluff %.% 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. AI understand that it is my responsibiiity to inform the Land & Resource Managemeivro r: - I - ) ---- ffice once the building footings have been constructed. Date: Signature of Property Owner/Agent for Owner Date: ^cr- C.jr-5 Land & Resource Management Official PROJECT(S) TOTAL SQ.PERMIT FEE $RECEIPT NO. Date StampComments: 2016( ■; .0 rESOUBCE i L&R InitialForm No. BK —04-2016 JmyjkJ. 360.647 • Victor Lundeen Co.. Printers • Fergus Falls. Minnesota w WHITE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) )ihln APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us a 'iOTTER TflllCOHITT-ailillOTI Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. -7' ■;5 . "'i SECTION TWP NO.RANGE TWP NAMELAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLAS^ 613 OMOi c. OTTr^'Ti^i o:: PARCEL NUMBER (S) - r cO - - O(j0^ - OO O - ( c,r - — cG>oq- OOP PROPERTY (E-911) ADDRESS f^A-r-r/c Lake, ^-AS!b LEGAL DESCRIPTION DEVELOPED •L \SfC UNDEVELOPED,; FirstLast Name Initial Mailing Address Daytime Phone No. '^'TTLC' Lake. —rgbjop 5Property Owner S . ‘it--’ $L0/vJis f: Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) (I) New Dwelling (4) MHA'R____ (7) Add'n To Non-Dwelling (8) Storage Structure (10) Non-Conf. Replacement (identify)" IJ . 'T (II) Other (identify) 112) 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. ( ) Compliance Inspection Report within 3 yrs. (Attached) OTWMD 'Must have Sewage System Approval / from OTWMD prior to issuing Site Permit. Contact Rottie Mann at 218-864-5533 ( ) New Septic Permit Issued Permit ft ( 2 ) Add'n to Dwelling/Attached Garage (3 ) Replacement Dwelling* ^ »(6 ) Detached Garage (9) W.O.A.S. (5) RCU/Year. ■a -i ■i•Removal of Existing Dwelling Verified by L&R "Existing Non-Conf. Structure Verified by L&R inspectofs Initiai/Date Inspector's Initial/Dale J CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension 1CHARACTERISTICS OF (Must Include Attached Garage) Outside Dimension _________ Sq. Ft. Setback to Lotline Setback to Right of Way i~'. ■ Ft." Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level Setback to Septic Tank i > Ft. Setback to Drainfield 1 i-.~ ^ Ft. Setback to Bluff Ft. Total Bedrooms Maximum Proposed Height Roof Change (v ) Yes ( ) No Basement ( ) Yes (\) No Walkout Basement ( ) Yes (side profile required) (' *) No CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension Ft. X Ft."Ft. X 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 Watwlevel __ 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. & y Ft.** Ft.& /Ft.**/ /Ft.**y Ft.** Ft.Ft.Ft. Ft. :-Ft.\Ft.•ti'. ,-L Ft.Ft.l2_Ft.Ft. Ft. ) 1-( ) Screen Porch ( ) Storage Structure ■y Topographical Alteration / Earthmoving ^ V, □ None U 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 Area.( )Yes ()()NoCHARACTERISTICS OF LOT:Sq. Ft.Water Frontage Ft.Bluff .%.%k. Building 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. 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. c., — i — I L-rDate: Signature of Property Owner / Agent for Owner ■ i /sDate: -Land & Resource Management Official aPROJECT(S)TOTAL SQ. FT. (o S ^ PERMIT FEE $7 O/ (o —: v:- e ■RECEIPT NO. * i r>C yi 7/' Ct JAComments: --4" \r‘ y ^ V. r ■* c/ • ,i I'•JJ 1IligBiForm No. BK —04-2016 360.647 • Victor Lundeen Co., Printors • Fergus Falls. Minnesota , ♦ SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations ______________ wl DgtK Hi 'loiVfi^J^UUfAte^S &/ 'Structure Set Back from Ordinary High Water Level Ft.Ft. Structure Set Back from Top of Bluff Ft.Ft. /oo^Structure Set Back from Road Right of Way Ft.Ft. -f 12t3b-Structure Set Back from Lot Lines Ft.&Ft.Ft.&Ft. /3>' V 'Structure Height /5’ /Ft.Ft. 5o^Structure Set Back from Septic Tank Ft.Ft. 60"'"Structure Set Back from Drainfield Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level Ft.Ft. Land Slope at Building Site %% \ 7Inspectori\ments / Sketch: I- ^'1 1^ to'ViV >>\ \ /' I ii i Inspector's Signature f hhi/tnI! Date of Inspection Time of Inspection { )L.Project Approved Date / Initial I iSCAUE DRAWING FORMI I f 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 and topographic features (i.e. bluffs). Must also complete the Impervious Surface Calculation (see back).i Scale ■■■)■+i T! ! o ; T; ! : : M 5' i1 ; j... -X)i r I I iI Signature of Property Owner Date BK —032014 MN • l-800-.146^870354.120 Vicioi Ltinriefln.Co, Primers Fergus Falls.! IMPERVIOUS SURFACE CALCULATION List & identify all existing & proposed onsite impervious surfaces on scale drawing. Lot Area (ft^):Signature:Date: Buildings Other Impervious Surface Existing Proposed Existing Proposed Ft^Ft^Ft^Ft Dwelling Deck(s) Attached Garage Patio(s) Detached Garage Sidewalk(s) Storage Shed Landing(s) WOAS Driveway(s) RCU Parking Area(s) Miscellaneous Retaining Wall(s) Landscaping (Plastic Barrier) Miscellaneous TOTAL BUILDINGS TOTAL OTHER Buildings Impervious Surface Percentage Maximum Allowable 20% Existing Proposed Total Lot Area Impervious Surface Ratio Ft^ Ft^Ft^ Ft^Total Buildings 100+-r=X Buildings + Other Impervious Surface Percentage Maximum Allowable 25% Total Buildings + Other Impervious Surface Existing Proposed Total Lot Area Impervious Surface Ratio Ft^Ft^Ft^Ft 100+X Impervious Surface Calculation Worksheet 03-25-2014 OTTER TAIL WATER MANAGEMENT DISTRICT 27234 368TH AVE. Battle Lake, MN 56515 Phone (218) 864-5533 Mr. Trevor Johnson 26565 State Hwy 78 Battle Lake Mn 56515 » TO: Otter Tail County Land & Management Office July 1,2016 This letter is in reference to the properties owned by Trevor Johnson P/n25000990608000 & 25000990609000. A new septic system was installed in 2013 to the District & State codes which serve cabins #3 & 4. Each has 2 bedrooms. All wells are the owner’s responsibility. If you have any questions please feel free to contact me. Thank You Sincerely, Roland R. Mann Administrator RECEIVED 1\\]^ 0 8 2016 land & RESOURCE 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 Ciass Section Twp Name ZGO Parcei(s) No.Property (E-911) Address I r.3S Property Owner Information: Name(s): Address: Daytime Phone: Type of Request: Bluff: Date Stamp Determination Stake Setback Verify Setback 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: A scale drawing must accompany Pre-Application Site inspection Request & request must be staked onsite Property Owner Date INSPECTION COMPLETED (Inspection must be done within 10 days of receipt): Date Onsite Date Property Owner Notified Inspector Fee:Receipt Number: Inspector must provide site drawing or field notes on other side. mbowman Application & Forms Pre-Application Site Insp Request Form 06/2012 5(^ ht cm;^-«5Z—f <^/ift;J ■A£vU / 3 ^ 4— >/ / 4 f/.c. '• 'DED / CA RECEIVED rz AUG 1 3 2014 lO" £' ET BALL COURT :v-^3i£,y2!LANL= & PESO'JRCE • WHITE - Office GOLDEHROD - 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 TWP NAMETWP NO.LAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE / RIVER NO. ill) 040OrltEX lAtL t^oe?rr>0^ PROPERTY (E-911) ADDRESS____ ^•nrce La>U( PARCEL NUMBER (S)-^2S-CCC -cbc? -cco -OC.Q LEGAL DESCRIPTION feL A 14'^»«« Daytime Phone No.Mailing AddressFirstInitialLast Name IiEacc Lcty "^TTLe LAK-Xrigvcg, SProperty Owner Z\^HCQ-CC26, Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add'n to Dwelling ( 5 ) RCU/Year_____ ONSITE SEWAGE TREATMENT SYSTEM ONSITE WATER SUPPLY J>^Tr7dividual ( ) 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) MHA'R____( ) Permit No. (^^TWMD ‘Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Roltie Mann at 218-864-5533 [7^ Add’n To Non-Dwelling ( 8 ) Storage Structure ( 9) W.O.A.S. ^^jjNon-Conf. Replacement (identify)" ^ Z (11) Other (identify) (12) Deck_______ •Removal of Existing Dwelling Verified by L&R IS *~"Existing Non-Conf. Structure Verified by L&R Inspector's Initial/DateInspector's Initial/Dale CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) ^ ^ ^ Outside Dimension Ft. x Zdg Ft." Sq. Ft. ^ Setback to Lotline | Ft. & 110 Ft." Setback to Right of Way V~1 t Ft." So»w4L -JfSetback to Ordinary High Water Level t.cBPsfinv\ Elevation Above Ordinary High Water Level___S_ Setback to Septic Tank 'Z\0 Ft. Setback to Drainfield "^30 Ft. Setback to Bluff Ft. Ft. X Ft." Ft. X Ft." Sq. Ft. Setback to Lotline Setback to Right of Wa^ Setback to Ordinary High W^er ifevel __ Elevation Above Ordinary Higl^ater 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 Wa Setback to Ordinary High \at^r Level __ Elevation Above Ordinary w® Water Level Setback to Septic Tank / Setback to Drainfield /__ Setback to Bluff________ Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection Ft.Ft."Ft.Ft." Ft."Ft." Ft.Ft. Ft. 1.Ft. Ft.Ft. Total Bedrooms Maximum Proposed Height Ft. Roof Change (AjTVes ( ) No Basement ( ) Yes ) No Walkout Basement ( ) Yes (side profile required) No Ft.Ft. Ft.Ft. ( ) Screen Porch ( ) Storage Structure • Must Include on scale drawing, additional Permit may be required. Topographical Alteration / Earthmovina □ None ijr20 Cubic Yards or Less • □ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More' CHARACTERISTICS OF LOT: Bluff ( )YesSq. Ft.Water Frontage .Ft.Lot Area, h/aY\~ CoKjfov-vwC Impervious Surface Ratio:X100 =Impervious Surface RatioTotal Impervious Surface Onsite (FTr) 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. ^1 understand that it is my responsibility to inform the Land & Resource Manag^ent office once the building footings have been constructed. NL-g-il-iHDate: Signature of Property Owner / Agent for Owner I Sc<T=^Date: Land & Resource Management OfficialPERMIT FEE $ .5^'^PROJECT(S) TOTAL SQ. FT. Y^RECEIPT NO. tsr^ Cobir> __"SClataSL lin^Date StampCommen RECEIVED AU6 1 3 2014 land & RESOURCE 10j f, ^Q5 i>6y( L&R Initial ^ Form No. BK — 04-2013-05 i*l. 351,158 * Victor Lundeen Co.. Printers • Fergus Falls. Minnesota WHITe^OffioS' GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor APPLICATION FOR SITE PERMIT C>u^1LAND & 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 \ Sl&5.\ \Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. RANGE TWPNAMETWP NO.LAKE/RIVER CLASS SECTIONLAKEVRIVER NAMELAKE / RIVER NO. OrTOt Iail OHO Eocrrs62. PROPERTY (E-911) ADDRESS____LoofPARCEL NUMBER (S)-OCpO? -OOO <— z S ~ OOP - - OlfO^ - poo I r LEGAL DESCRIPTION Mailing Address Daytime Phqre No.First InitialLast Name iliAtL Locfi WroT M .\ov4A)&y4 • rigvfae SProperty Owner f-"i T“; T-^Contractor Name Lie.# )/I 7^ / /13?^ X'. " ‘ • . . V • -PROPOSED PROJECT (please circle the appropriate number)ONSITE SEWAGE TREATMENT SYSTEM ONSITE WATER SUPPLY 'Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well TJtJde) requires a 3’ (minimum) structure seftack to a well. (3) Replacement Dwelling* (6) Attached / Detached Garage (1) New Dwelling (4) MHA'R_____ (2 ) Add'n to Dwelling ( R i RClI/Year !i( ) Permit No. (^^TWMD 'Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Roltie Mann at 218-864-5533 f' ^^TWaiTIbTjon-Dwelling ( 8 ) Storage Structure (9) W.O.A.S. ~ ^^tJon-Conf. Replacement (identify)" nT ^ Z r ^AhTL L^CATt*^ 'rdentify). i r (1 t (12) Deck_S •Removal Of Existing Dwelling Verified by L&R iSspeaoTs Inilial/Dale "Existing Non-Conf. Structure Verified by L&R j. Inspector’s Initial/Date CHARACTERISTICS OF PROPOSED W.O.A.S. i (WATER ORIENTED ACCESSORY STRUCTURE);CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage)I'Outside DimensionX 2(p (e Ft. X Ft."Ft.**iFt. X Ft.**3 SO. Ft. Setback tb Lotline j h* Ft. & Ft." Setback to Right of Way \~T \ Ft.** Setback to Ordinary High Water Level —fwHr I ]Sq.Ft. Setback to Lotline . Setback to Right of WaK Setback to Ordinary High^ter level Elevation Above Ordinary High')^ater Level Setback to Septic Tank__ Setback to Drainfield___i Setback to Bluff________ Maximum Proposed Height Roof Change ( ) Yes ( ) No Bathroom Proposed { Yds - **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection i Sq. Ft. Setback to Lotline Setback to Right of Wa^ Setback to Ordinary High Level ____ Elevation Above Ordinary Water Level Setback to Septic Tank Setback to Drainfield / Setback to Bluff_____ f*I Ft.Ft.**Ft, t-cOfprt Ft.**ic>y\Ft.**fFt.]r.K.Ft.iElevation Above Ordinary High Water Level Setback to Septic Tank '2)0 Ft. Setback to Drainfield ‘*130 Ft. Setback to Bluff Ft. Ft. tjT iFt. );Ft. Total Bedrooms Maximum Proposed Height Ft. Roof Change (-^TYes ( ) No Basement ( ) Yes ) No Walkout Basement ( ) Yes (side profile required) No t Ft.!Ft. Ft.ii AiMaximum Proposed Height (.) Boathouse ' (i ) Gazebo Ft. tJ!(f ) Screen Porch ( ) Storage Structure • '•-'io pt * Must include on scale drawing, ** additional Permit may be requiree ---------------------------------------1------^ Topographical Alteration / Earthmovina □ None ' 19”20 Cubic Yards or Less * □ 21 Cubic Yards - 299 Cubic Yards* 7.. bi r.□ 300 Cubic Yards or More*■i iCHARACTERISTICS OF LOT: L-)24-^Ts1 Sq.ft.ii j ; ■ j i ‘ v V'.L.. I' -v:" ______________:___tpk Impervious Surface Ratio ' Bluff (') Yes (if-) No.Ft. .Water Frontage _lLot Area. 1t aJo.r Impervious Surface Ratio':X100 =:• Total Impervious Surface Onsite (FT^)Total Lot Area (FT^) ms 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 footings have been constructed. I - SU IV.___ _______i Signature of Property Owner/Agent for Owner Date: r I \ 7^Date: Land & Resource Management Official t>0PROJECT(S) TOTAL SQ. FT. 1 PERMIT FEE $ ■'RECEIPT NO. J I ' /Commentsyi- { Cihilr-, Tg.-)f Sv'.U.Wv F I f'l 11 nJ) .1 n:T '■-X' ■ -- ' / ii ■j/ d[iisaForm No. BK — 04-2013-05 351.158 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Ft.Ft.Structure Set Back from Ordinary High Water Level Ft.Ft.Structure Set Back from Top of Bluff Ft.Structure Set Back from Road Right of Way Ft. \'W Ft.&Ft.Ft.&Ft.Structure Set Back from Lot Lines )1 Ft.Ft.Structure Height Ft.Ft.Structure Set Back from Septic Tank &CXi^Ft.Ft.Structure Set Back from Drainfield Elevation Of Lowest Floor Above Ordinary High Water Level____________________Ft.Ft. Land Slope at Building Site %% lA ui'tw oii^rInspector’s Comments / Sketch: o\cJ cc.\nii^ \ 2D.\ V'-'’■A ' ic-biA Pllf. Inspector’s Signature Date of Inspection Time of Inspection ^Proyecf Approved //4l^ Date / Initial' I ISCALE DRAWING FORM 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...t.. % Impervious Surface Ratio (Must Complete Worksheet On Other Side) Scale i V >oo 4- r-■i o\~1 •T' _S>i T -f- .1..1 ■r"i ■r.1..1 ....■I'■r i "1 i- i r ,l. ■rI .... ^sl r z i/CiA i c5 j 2 ■i RECEIVED /AUG 1 3 201^LU A-LAND & RESOURCE I ' Date' ■I nSignature of Property Owner BK — 0909 338.596 * Victor tundeen Co., Pnr^tars * Fergus Falls. IkM • 1-800-346-4670 IMPERVIOUS SURFACE CALCULATION WORKSHEET: List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scale drawing): 4n £ g Ft^Structure(s): Ft2Deck(s): Ft2Driveway(s): Ft2Patio(s): Ft2Sidewalk(s): Ft2Stairway(s): Ft2Retaining Wail(s): Ft2Landscaping: (Plastic Barrier) Other:Ft2 Ft2TOTAL IMPERVIOUS SURFACE: Ft2LOT AREA: %X100 == IMPERVIOUS SURFACE RATIOLOT AREATOTAL IMPERVIOUS SURFACE in. V / z:/r / L 14/(c /sj ^ < * I Fiti ff9w*0 Ji \1 ?•i‘ *•s fis >1 .•••. .■* V s*' '\ \/ /\• • ,.1I!'7 ■ V pBfMS ppiS^:'**1 msimm. TT. /<r IfK<r ; -\I cX5 ^ V. ^ - ~ V?^ .'s/y. ‘*3H • '-a ' r„i mr£.\o_i 1;r Iiti 3i .5ti IBI/■:•: IL^i.. i V. i YMd. ^v.-'vC.- i.I 1si afc*'i. -1 5^-;\i ?5i-.i -la «GoO■| XCfI ^3 i. - i. -I\ O ^,1* ° s/ i. -f \ m !§I»*a r*»iCD \“r.// *0 t f/,a. '•I '5^i I i • j0/r/€\ i,\ \ROAD! 50. 00 fj 56 ^00'00' f15DED / CA RECEIVED AUG I 3 201^ >/ sm^ii)0' £ ET BALL COURT 21.5^sT^'*-4. LANL; 5. r’ESCl'RCE OTTER TAIL WATER MANAGEMENT DISTRICT 27234 368TH AVE. Battle Lake, MN 56515 Phone (218) 864-5533 Mr. Trevor Johnson 26565 State Hwy 78 Battle Lake Mn 56515 TO: Otter Tail County Land & Management Office August 8,2014, This letter is in reference to the properties owned by Trevor Johnson P/n25000990608000 & 25000990609000. A new septic system was installed in 2013 to the District & State codes which serves cabin #2 & its 2 bedrooms at the resort. All wells are the owner’s responsibility. If you have any questions please feel free to contact me. Thank You Sincerely, Roland R. Mann Administrator received AU6 ) 3 20f4 land & RESOURCE 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 structures, septic tanks, drainfields, lotlines, road right-of-ways, easements, OHWLs, weiis, wetlands, topographic features (i.e, bluffs), and onsite impervious surface calcuiations. % Impervious Surface Ratio (Must Complete Worksheet On Other Side) Scale rr\ <■<0O 3" 7 --4- h- )■ V -3 i ! tr I l^/ A■; A/ 2!of■ qA 5\Ai 4 ^ < CJ Vi 4i ai RECEIVE AUG 1 3 2014 LAND & (iLbiw' /Wi4J/\»vrL 1 Signature of Property Owner Date BK — 0909 338,596 • Victor Lundeen Co.. Printers • Fergus Falls. MN ♦ 1-800-346-4870 IMPERVIOUS SURFACE CALCULATION WORKSHEET: List of Onsite (Existing and Proposed) Impervious Surfaces fmust be shown on scale drawing); , 7^ Ft^Structure(s): Ft2Deck(s): Ft2Driveway(s): Ft2Patio(s): Ft2Sidewalk(s); * Ft2Stairway(s): Ft2Retaining Wall(s): Ft2Landscaping: (Plastic Barrier) Other:Ft2 Ft2TOTAL IMPERVIOUS SURFACE: Ft2LOT AREA: 7oX 100 = IMPERVIOUS SURFACE RATIOTOTAL IMPERVIOUS SURFACE LOT AREA i '''N h c^/ ** / Ti I o' ! SCAMID V \ Qg/2Q/2014,14:35:14 If ^«/7rrf?mi .1 3—5?!S2^E ai* 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 GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor Z-(o2-30Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. TWP NAMETWPNO.RANGESECTIONLAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO. OZ OMO b'J6T2.'T5,Sis-V'rrEiz- PROPERTY (E-911) ADDRESS _'SSS'SiT VA->A^t>rs> Traic Loop "EA-TTce: La\c-e:,:Lr-r^-<iCf-oCoH -goo LEGAL DESCRIPTION Lcrr 3> Daytime Phone No.Mailing AddressInitialFirstLast Name uoA^()Aj"~^'gAr^ 'RAr-rrz.c ‘SWS'lS' l^6»fro$oo' I reopR ^'A?ACAT>CK;LAAiy> SProperty ^gsss Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling ( 4 ) MHA'R (^Add'n To Non-Dwelling ^rj^Non-Conf. Replacement (identify) _ (11) Other (identify)______________ (12) Deck______________________ 'Existing Dwelling to be removed prior to. ONSITE SEWAGE TREATMENT SYSTEM ONSITE WATER SUPPLY jj^ndividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure )l>e|back to a weil. (2) Add’n to Dwelling ' RBpia ( 5) RCU/Year________ (6 ) Attached / Detached Garage (8) Storage Stru^r^ ^ (91 W.0.AS. CCIMCI ( ) Permit No. OTWMD ‘Must have Sewage System Approval trom OTWMD prior to issuing Site Permit. Contact Rotlie Mann at 218-864-5533 ?<l.v|’€2 ^-\S-20\\ CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELUNG Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage)^ r . ^fe> U * Outside Dimension xSq. Ft. M g O Setback to Lotline Setback to Right of Way I T 1 Ft." Setback to Ordinary High Water Level (j \ Ft. Elevation Above Ordinary High Water Level O Ft. Setback to Drainfield 1S~1 Ft. Setback to Bluff Ft. Total Bedrooms Z. Maximum Proposed Height I ^ Ft. Roof Change t^) Yes ( ) No Basement ( ) Yes (V) No Walkout Basement ( ) Yes (side profile required) No Ft. XFt."Ft. X Ft." Sq.Ft._____\ Setback to Lolling Setback to Right of^y Setback to Ordinary Hi^Wptdr Level Elevation Above Ordiiw^gh Water Level Setback to Septic^nk__ Setback to DrSmifield____ Setback to Bluff ____ Maximum Proposed Height Roof Change ( ) Yes ( ) No Bathroom Proposed ( ) Yes ( ) No n€i Sq.Ft._______\ Setback to Lotline\___ Setback to Right of Way Setback to Ordinary troh Wat^ Level __ Elevation Above Ordipatv High Water Level Setback to SeoJidT^nk ^ Setback toljrainfield____ Setback to Bluff________ Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection n Ft."Ft.& Ft." Ft. Ft. Ft.Ft. Ft.Ft. Ft. Ft.Ft. ( ) Screen Porch ( ) Storage Structure * Must include on scale drawing, additional Permit may be required. Topographical Alteration / Earthmovina □ None ^ 20 Cubic Yards or Less * CHARACTERISTiCS OF LOT: □ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More' 15-2 Bluff ( )YesFt.Sq. Ft.Water FrontageLot Area. vZOZl 7-0.zn .%Impervious Surface Ratio:xioo = Impenrious Surface RatioTotal Lot Area (FT')Total Impervious Surface Onsite (FTO 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. \L^!?-2S-i;Date: Signature of Property Owner / Agent for Owner Date: Land i Resource Management Official PROJECT(S) TOTAL SQ.FT./^Sr-----PERMIT FEE $RECEIPT NO. Date StampComments: £received AU6 2 3 2011 OURCE nK -K) gQiosfvLtf L&R InitialForm07-2011-05 / APPLICATION FOR SITE PERMIT^ WHITE - Office - Inspector I 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 -‘iMmer (after issue) PINI^ - Assessor •Z-t2.50Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.i RANGE TWP NAMETWP NO.LAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE / RIVER NO.1OMO0nh vJtTFTSS~(f - 7MZ O-TTn?-' TH\i L- PROPERTY (E-911) ADDRESS'T, PiT, S \jOf\ ^ A (C L O OfG T^-r-rLtr I CLrCriC* PARCEL NUMBER (S) T-- 7'7-0(^oW-WO ~c?oo LEGAL DESCRIPTION Lcrr Daytime Phone No,Initial Mailing AddressFirstLast Name iK'ifer.nAi l>?AlL / nn^_____ LAKl- Property Owner \<: T?A -r T ^ c <^ir /ii /rContractor Name Lie. # PROPOSED PROJECT (please circle the appropriate number)ONSITE SEWAGE TREATMENT SYSTEM ONSITE WATER SUPPLY jVi^1ndividual NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure I. ClLfTt j^tback to a well. *ReplaGemeHLOiNaUiag_ ) Attached / Detached Garage ___ ( 9) W.O.A.S.il r (2) Add’n to Dwelling ( 5) RCU/Year_____ (8) Storage Structure (1 ) New Dwelling (4) MHA'R (7 ) Add’n To Non-Dwelling t^2fcNoh-Conf. Replacement (identify) (Tf) Other (identify)_____________ ( ) Public ( ) None ( ) Permit No. ^) OTWMD 'Must have Sewage System Approval from OTWMD prior to issumg Site Permit. Contact Roiiie Mann at 218-864-S533 (12 ) Deck______________________ 'Existing Dwelling to be removed prior to.. tC[, |c; ,jrt\ CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELUNG (Must Include Attached Garage) Outside Dimension Sq. Ft. ^ Setback to Lotline ~~7 Ft. & t Ft." Setback to Right of Way H * ^t.” Setback to Ordinary High Water Level ! r I Ft. Elevation Above Ordinary High Water Level Ft. Setback to Septic Tank L'' Ft. ^ Setback to Drainfield )Ft. Setback to Bluff ft Ft. Total Bedrooms T’ Maximum Proposed Height ) ^ Ft. Roof Change Yes ( ) No Basement ( ) Yes (^) No Walkout Basement ( ) Yes (side profile required) (y-) No tfi-'kx Ft."Ft. XFt."Ft."Ft. X\ Sq. Ft. Setback to Lotlin^ Setback to Right of W^y \Setback to Ordinary High Water Level __ Elevation Above Ordinarylligh 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 \**Ft.&Ft."Ft.&k** Ft.Ft. Ft.Ft. Ft.\Ft.V Ft.Ft. Ft. Setback to Bluff________ Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection R. Ft.Ft. ( ) Screen (>orch ( ) Storage Structure * Must include on scale drawing, additional Permit may be required. Topographical Alteration / Earthmovino □ None CHARACTERISTiCS OF LOT: □ 300 Cubic Yards or More*□ 21 Cubic Yards - 299 Cubic Yards*□ 20 Cubic Yards or Less * Bluff ( )Yes (y)^o .ZOTl .Ft.Sq. Ft.Water FrontageLot Area 7.0.zn___Impervious Surface Ratio Impervious Surface Ratio;{&! •:r\ -------------------------- Total Impervious Surface Onsite (FP) .1 X100 =.%Total Lot Area (FTr) 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 Manageigent office once the buiiding footings have been constructed. IIDate: Signature of Property Owner/Agent tor Owner Date: Land & Resource Management Official !RECEIPT NO. /^LdyS^PROJECT(S)TOTALSQ.FT._j^^ o/•PERMIT FEE $------ ! pi - Av\^llvj Nlf.VComments: ■vlvX!V I r\( / fi \ - I [’y ^ Pii ^ t v 0^"' &K 1.V i ,f 1 I u V , ;v.| c-/i f v\ > (/O.L -1 -,1, I 345.196 • Victor Lundaen Co.. Prirttefs • Fergus Falls. Minnesota-teaForm No. BK — 07-2011-05 SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Ft.Ft.Structure Set Back from Ordinary High Water Level Ft.Ft.Structure Set Back from Top of Bluff /f2> -Ft.Ft.Structure Set Back from Road Right of Way Ft. & //S'-1'20-Ft.7 Ft.Ft.&Structure Set Back from Lot Lines L /3 Ft.Ft.Structure Height Sit Ft.Ft.Structure Set Back from Septic Tank IOC)t Ft.Ft.Structure Set Back from Drainfield Elevation Of Lowest Floor Above Ordinary High Water Level Ft.Ft. Land Slope at Building Site %% Inspector’s Comment/ Skefci I I IS'iw! ii»1-4l %-2V i 1 //S-izot %V/ii. Inspector’s Signature 'A Date of Inspection \ ■fme of Inspection M K ER uaie / initialAProject Approved! fio :^ooiBattle Lake Review08/30/2011 10:36 FAI 12188645212! h ' |V[A£GI/4 RECEIVED m 3 0 2011 LAND & RESOURCE OTTER TAIL WATER MANAGEMENT DISTRICT 27234 368TH AVE- Baitle Lake, MN 56515 Phooe(218) 864-5533 Mr, Tyler Johnson 26565 St Hwy 7^ Battle Lake, MN-55113 TO: LAND & RESOURCE MANAGEMENT Aug. 30,2011 This letter is in reference to the septic system at p/n 25000990608000. This system was installed in 1977 & certified by the County. At this time it is functioning ok. The district has no problem with a permit being issued to replace the existing structure with a new one, as long there are no bedrooms added. If you have any questions please feel free to contact me. Thank you Sincerely, Roland R. Mann Administrator <^ / / zr/r /Sj ((9900 ;ii fh900 \V s V H•St z^ ■ W-iMMkc 1111^ iti- 4(O Vt- ^ £5. k, %4s.Trtt X, *\lc:::. ^ ►-j ^i>. ■ cs, « ys ^ 4o_ sn ;;:s P\4 IH" 4 I 1 L-^4 1 4 iv:54eecfi'v: \4 'looO9for m•>4 4> iili4 %/:s 4*■f5k I !Ttti CDI \*»!.//IVO f/... *»V* ^ *5i r1 *t»/ltl€ /?o:^D150. 00 N 86*00'00" £D ED / CA ?7 W" £ '£r BALL COURT 21.5^ Bf-'iiTir^'K Cab!" 1 »^(zo-f.z’^•*5 VJ ;I :I ^j\Z p^Ti^HI I I i i! ' IZ’Z"i 1 iI1i!III I i (I 1 Y yf \ i I I1 I 'I 1 oU *ZOx‘2m)i ;;lOevvj CaS*'^ ^ ^!! /■-~Xu. A :ij?/\7r pHcrt t I ii ;I i2' i ; i ! 1 1 I SuAi o*^ 6gA>e \r 1 1I Pre-Application Site Inspection Request Twp NameLake/River Class SectionLake / River No. Lake / River Name y\i-eA-y&D Z— Parcel(s) No. Property (E-911) Address Property Owner Information: / r \J (X(j)JrtcY\ [oMd QoliA^^on V5yy u/gyi nn- idop _____ Name(s): Address: Daytime Phone: Type of Request: Bluff:Verify SetbackStake SetbackDetermination OHWL:Verify SetbackStake SetbackDetermination Stringtest:Determination Non-Conforming Repair or Replacement Structure:Confirm Consistency With Existing Structure Miscellaneous:______ Describe Request:^^{qlLu/^ Cp-icm rlcM-ZOtSiOlQ — A scale drawing must accompany Pre-Application Site Inspection Request & request must be staked onsite k-2Z'HIDateProperty Owner ^->>00 (IReceived By: DateLand & Resource Management Staff INSPECTION COMPLETED (Inspection must be done within 10 days of receipt): Date Onsite Date Property Owner Notified Inspector (Inspector must provide site drawing or field notes on other side.) mbowman Application & Forms Pre-Application Site Insp Request Form10/1/07 LaK^ Ci^SrrfCf^<Af'^ :tfH ^•2-I'L-^^3^6-' G>" i^ L- . 5//'h'^ pgiufeu«.y •> V^/'/ ^6 Qm *n of >0 r 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 GOLDENROb - Inspector YELLOlif - Owner (after issue) PINK - Assessor Permit No.PLEASE PRINT OR TYPE ALL INFORMATION ! ^CTION J2 '' 125 PNAME,NGEP NO.^AKE/RIVER CLASSLAKE / RIVER NO.E/RIVER NAME 40 (^oerb*)-hfef'{r(x • (L PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) SBSSS' (^i5Soi2Jr LEGAL DESCRIPTION &LJ? /}r<, ‘ ~ Daytime Phone No.First Initial Mailing AddressLast Name dJ ■Property Owner .K\ ^/t> ^~L €50^ jdSiSt'J_^ ^UTcne^^JJ,Contractor Name Lie.# cm I? TrdA- J?2Z- Sapo lHonsite sewage TREATMENT SYSTEM ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add’n to Dwelling ( J«)^eplacement Dwelling (5) RCUA'ear. (1 ) New Dwelling (4 ) MH/YR_____ (7 ) Add’n To Non-Dwelling ( 8) Storage Structure ( ) Permit No. (^ OTWMD 'Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rollie Mann at 218-864-5533 ( 6) Detached Garage (9) W.O.A.S, ,<Cy. c7(10) Other,'Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED DWELLINGOutside Dimension Sq. Ft. /f 7^ Setback to Lotline Ft, Setback to Right of Way _________ ^ Setback to Ordinary High Water Level ^ ® Elevation Above Ordinary High Water Level Setback to Septic Tank / > *' F#^ Setback to Drainfield Pt.>Z' Setback to Bluff Total Bedrooms 2. Maximum Proposed Height Roof Change ( ) Yes (No CHARACTERISTICS OF PROPOSED NON-DWELLING Outside DimensionFt. X _J_Outside DimensionFt.Ft. X Ft." Ft. X Ft." Sq. Ft. Setback to Lotline ___ Setback to Right of Way 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."Ft.&Ft." Ft."Ft." 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 \Z Bathroom Proposed ( ) Yes ( ) No Ft.Ft. Ft. Ft.Ft. Ft.Ft.Ft. Ft.Ft.gP ^ Ft.Ft.Ft. ( ) Screen Porch ( ) Storage Structure Basement ( ) Yes No Walkout Basement ( ) Yes (side proliie required) ) No Topographical Alteration / Earthmoving I^Lblone * Must include on scale drawing, additional Permit may be required.20 Cubic Yards or Less *□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT: Lot Area ^39 Bluff ( )Yes ((/) NoSq. Ft.Water Frontage .Ft. Total Impervious Surface Onsite (FTq Total Lot Area (FT') Impervious Surface Ratio:X100 =.% 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 vvorkmen 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 office once the buKding footings have been constructed.lurpe ii^agei y^1 Date: Sjarmturo^Prog^i mkr / Agent for Owner 1Date:eJeLand & Resource Management PERMIT FEE $PROJECT(S) TOTAL SQ. FT.RECEIPT NO. Comm j 4-----Ytxi For* Wo. BK — 1003-051 326,151 * Victor Lundeen Co., Printers ■ Fergus Falls, Minnesota GOLDENROD - Inspector WHITE - Office >APPLICATION FOR SITE PERMIT 0^ 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 YELLOUf - Owner (after issue) PINK - Assessor 2'>CX^iPermit No.PLEASE PRINT OR TYPE ALL INFORMATION RANGE P NAME^ECTiON ymPNO.LAKE/RIVER NAME UKE/RIVER CLASSLAKE / RIVER NO. HD /'cerh\y -2 !350 J-g « / PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) 3SSSS' r-, ^ QtS^>nT~ LEGAL DESCRIPTION Daytime Phone No.Mailing AddressLast Name First Initial (Y t I >-y ciIProperty . Owner sss-r> [Jrrrie*^ JJ.\Contractor Name Lie.# i cn2 € /VP. S/,P7Z^ \S3pO y' ONSITE WATER SUPPLY ONSITE SEWAGE l/() Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. PROPOSED PROJECT (please circle the appropriate number) ( 2) Add'n to Dwelling ( 5) RCU/Year_____ (8) Storage Structure _ ‘Existing Dwelling to be removed before. TREATMENT SYSTEM(X^fteplaoement Dwelling ( 6 ) Detached Garage (9) W.O.A.S. I(1 ) New Dwelling ( 4 ) MH/YR ( 7 ) Add’n To Non-Dwelling (10) Other ( ) Permit No. (^) OTWMD 'Must have Sewage System Approval from OTWMD prior to issuirtg Site Permit. Contact Roltie Mann at 218-864-5533 CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension _ Sq. Ft, 4 7^ 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 2*'^ Ft.»^ Ft.X /y Ft.'^"'Ft. X Ft." Ft. X Ft.” Sq. Ft. Setbaok to Lotline ___ Setbaok 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 Appiication / inspection Ft."Ft.&Ft."Ft.&Ft." Ft."Ft." Ft.Ft. Ftr-^/f ^Ft. Ft.Ft. Ft.Setback to Bluff Total Bedrooms 2 Maximum Proposed Height Roof Change ( ) Yes (1K) No Basement ( ) Yes ^) No Walkout Basement ( ) Yes (s/de profile required) rL,7 ) No Ft.Ft. Ft. Ft.Ft. Ft.Ft. ( ) Screen Porch ( ) Storage Structure 1/ Topographical Alteration / Earthmovina -None 3B( 20 Cubic Yards or Less * □ 21 Cubic Yards - 299 Cubic Yards* * Must include on scale drawing, additional Permit may be required.□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT: Lot ^3^Bluff ( )Yes (I^NoSq. Ft..Ft.Water Frontage Total Impervious Surface Onsite (FT*)Total Lot ^ea (FT^) U--1.Impervious Surface Ratio:X100 =.% 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. r--7 /sA--1/. JDate: ____ _ f -« ’_________________Sigtiature or Propeofy Owopr / AgerU tor Owner y yD '77 / / /Date:TJTcLand «S Resource Management Office /////S'?PERMIT FEE $PROJECT(S) TOTAL SQ. FT..RECEIPT NO. y /I Y)/d YP) . J-^yUyjP. 1 C A7 5/ AI /r- 4 -tComments: ,Jih. AynuJ- yy /Pi ^ ■ ijnyjfnt,. Sc ■■■”A// y AOK Do4-r AliA-yy''L. <■"y / yyC-7,A / . . Form No. BK — 1003-0506 326,151 • Victor Lundean Co.. Printers • Fergus Falls. Minnesota r SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations )ii / ReP- 3001 Ft.Structure Set Back from Ordinary High Water Level Ft. Ft.Ft.Structure Set Back from Top of Bluff 3v*Ft.Ft.Structure Set Back from Road Right of Way 30-^ Ft. & Ft.Ft.Ft. &Structure Set Back from Lot Lines C. Zo'Ft.Ft.Structure Height Ft.Ft.Structure Set Back from Septic Tank 75*’Ft.Ft.Structure Set Back from Drainfield Elevation Of Lowest Floor Above Ordinary High Water Level __________Ft.Ft. Land Slope at Building Site %% Inspector’s Comments/Sketch: l^ocAr^o 13oot 1' '30 1 OOfeLt4 s 60"'------ T \ ■71 J C tnsf. ector’s Signature 'i'l Date of Inspection I Time of InspectionOPCl-t, ^ Project Approved Date/Initial (V HW'I I •*^ V'> ^ ;,//v/y:"'t‘ '■;? ■lA/(iE: -,. '?■ -.-■■■ . . HI . ■’ ■ 5Ste~tete v-v , Y -."f.’^^'»=.rTr iV '■ ' fffir I’.-’..■•••■'.■•»'■'• 1 ■ •:'■:'< ■■H’. V' I.--‘ /’^ as-^/ps- *1 *'. *> K\‘i't- '■■ '%■*1 , :t - \■ ^ to IVj,11:3 } \:illli-\ ..1 ■ ■ ^T ' « ■?'!:i■%m ’:•'1{-■:.: mliI‘Y V iiifliiifi&is.. s."i;i ■r’-i;'' i.'■(,: '; !ii';:;;-viii:i!:«;:!;5;::/ I >:■ ' ■'. !v S^iSvliil mmm^ •»•s.i I. t %I'-?:vif , % • V 5^"; ••: ■'•r ‘V I -5.1 ■-;■\ ;:!■■■'; f ■.r •■■fe': f ''■' )■? ■' ■'h':. 4<:-;:’,v'.’k-l‘i:!,’'f’.-;-!->’ i>,’.'.,-.Vv,-.'.',-,r.;;N miiiliii' siasfe'iii- %:.• 1 §’■ **,■i>56i>; ■?i■■.y-■■■:■:Ji:r f v>‘: ■ ■:• .1:'lilHf ■■■■■•■■■'■■ =^y''y->,U;.;V bI ;:H m r;:>i.!:»X • i"' f -•;. -t iS1 i .;i;!i ' • • t'.'» • » •••f ":#?(» Y;' -... n..;,. .V A*.ii;i : .-9. K-r/.'V''I" ^11 =“ >■f ;■ P MBS *•'.{ .KM . I ^ >0 S!.r kmc: , ::*r.r i;.'-:i; V •'•* -' ’.- ;:.Yi!||c::i.>K kcS:$: ^ Ic a Js: O ■iS;c «s%n. 't'T'i'• •fU Wgj|| j 1M:M’N/fSm'fK cy 'Si KN/';;i 1 :•J ^M-'E 'N ■.■■/M.n/yf/f j : «Vv iMii'; s E •lii »5 ', I,;;jp ■ly'DED / CA:r ........ - . g ss*Pfl 'oo^ ^ ' ^ P4^/fSr BALI CQUBT J/T” ■ .:-...■ ^'.i:21^54\ \ Be or i ng o w VV^M' J iCi'S ir!;Y;: 'C'»:C|#K5 . ..'PcM 1^ W-W I ilCprklti ■? **5Pip |!teS|ij iifsi I" - ytTI■'•if- pK I 1■ Mif mL?i V AfK-S I :Ai■( T’..E'';,x’ sc '■'.'y ' ■ *x .■t ■ i't / I .V,% ■'h. NQAi psBMANeyr sr/fi/eruBfs 7'‘l «sJl W'A*i //M/;yP'fK.Q ■' ^-;- k .;'iil«y ,:i.l • >:•-:■K .!, \l CioMoriW^ ^€5orf” m -1iPr__ . ir r fi,:'';*CfS"'S'i’■ I''''""' ' i'tvp' VVT.''?'y'■ ■ • * ! k ■ '■<,- .A) issK^" N <?>■y ilijlk , . H I'Y t-iiy-A yi •-' S'if* '4 S“ y S’f.-- •-Stey'^.a':,. - A ■''i. ^1 •'. (ft ’.5 •{ n. ■-.,-4- •:-- .V . ;‘/,- ,;>•,-i • y.. . i?-;.:t. f, Ific,Ks :Cy-i. Kyirl 'laiYl- 1 •; •u ':,,'V*--k''S'‘''''y • • .■1’.*'. . , h *;•■' i >'5.'Vl -A*..••!■ tT I *Hi T Jr- V ■ • ■■' .K‘ 1. ’/.in ■I 'ic *I ■ VAV t I ;;! / ADDENDUM TO APPLICATION FOR SITE PERMIT Acknowledgment and Agreement I am seeking a Site Permit for placing a dwelling on a lot upon which a dwelling already exists. I understand that the Otter Tail County Shoreland Management Ordinance only permits one dwelling per lot. I understand that a Site Permit issued for the new dwelling is with the specific understanding that the existing dwelling will be removed from the lot. I agree that only one of the dwellings will be occupied at any one time, and that the existing dwelling will be removed from the lot on or before of a Site Permit does not entitle me to have two dweMgs on the Igk . I understand that the issuance y- 7 roperty Owner SignatureDate MB FormsIApps-Addendum to Site Permit IWHITE- Office . GOLDENROD - Inspector YELLOW - Owner.(affer issue) PINK - Assessor ■ -s 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 PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE/RIVER CLASS SECTIONLAKE/RIVER NAME TWP NO.RANGE TWP NAMELAKE / RIVER NO. ' S'c V ^ \/)TreerrYjri-.(?-D PARCEL NUMBER (S) DO T _____I5vi7^ loof> LEGAL DESCRIPTION ry.P IcT ^ / SJ, i/e S d' ^ ^ ^ Corner ^ /r2.2Z P-~ ^oe S ^ £. ,a.-t do /s j-r Ptne, /7>. d e /^clrfr PROPERTY (E-911) ADDRESS Mailing Address Daytime Phone No.FirstLast Name Initial 3:V,Property - Owner L / Contractor i Name . Lie. # PROPOSED PROJECT (please circle the appropriate number) ■ <Lg~)lAd?n^o DvjSllit^g (5) RCU/Year_____ ■ ( 7) Add’n To Non-Dwelling (8 ) Storage Structure (10) Other. ONSITE WATER SUPPLY t(y^dividual ( ) Public ( ) None NOTE'. MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ( ) Permit No. ^,f>^^TLSD * TMs permit is oniy vaiid alter verification from the O.T.LS.D. that a conforming sewaga system wit! be instaiied to service this lot contact Rollie Mann at 864-5533. (1) New Dwelling (4)MHA'R___ (3) *ReplaceiTient Dwelling (6) Detached Garage (9) W.O.A.S. •Existing Dwelling to be removed before CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside _Dimension / Ft. x Ft."Ft. X ^----- Ft." Ft."Ft. XSq.Ft.j^J^ , Setback to Lotline / p Ft. & Setback to Right of Way ■£> ^ Ft." Setback to Ordinary High Water Level ■P'r^ti ^ Ft. ' Elevation Above Ordinary High Water Level -3 ^ Setback to Septic Tank : Setback to Drainfield 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 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 Appiication / inspection Ft.**Ft.&Ft.**Ft.**Ft.& Ft.**Ft.** Ft.Ft. Ft. Ft.Ft. Ft.Ft.Ft. Setback to Bluff ’ Maximum Proposed Height Basement J______ Walkout.Basement _ Total Bedrooms O Ft. Ft. Ft. Yes No Yes No Ft. Ft.Ft. Ft.Ft. ( ) Screen Porch ( ) Storage Structure Topographical Alteration7 Earthmoving □ 20 Cubic Yards or Less * * Must include on scale drawing Permit may be requiredo^-N □ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More*one CHARACTERISTICS OF LOT: :P/p inf Yes —N?Water Frontage BluffLot Area..Ft. .^0Impervious Surface Ratio:X100 =.% Total Impervious Surface Onsite (FT^)Total Lot Area (FT^)Impervious Surface Ratio THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. -Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above'set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express ' 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 Ordnances.. l understand that it is my responsibility to inform the Land & Res^ce Management office^ce the building footings have been constructed. V- 7-^ YDate: Signal^of^perty Ownej V- 7-OYDate: Land & Resource Management Office ^3X I271S'0PERMIT FEE $ 7 ^PROJECT(S) TOTAL SQ.FT.,RECEIPT NO. Comments: Form No. BK — 1003-0501 315,901 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota WHITE - Office ' GOLBENROD - 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 PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWPNO.RANGE TWP NAME <6 V z 6^/33 3l'/rrs9 PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS y 33. >>/ i/c sf ef / ' "I I - ' t,jct ///'r ^ LEGAL DESCRIPTION C Last Name First Initial Mailing Address Daytime Phone No,S/^ /cJa iV r J(k/f /ttf1 J’/i S^-9 ^Property Owner - i.^ [ lltAS.trx ^ rlri U-f 3okv\ c. nV)H nt4 -9GV rContractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling (4) MH/YR_____ (7) Add'n To Non-Dwelling (8 ) Storage Structure (10) Other. ONSITE WATER SUPPLY ■(,) Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEMcC.2 )/dd’n^to Dwellirlg ( 5) RCU/Year______ (3) 'Replacement Dwelling (6 ) Detached Garage (9) W.O.A.S. ( ) Permit No. ..P*4'0TLSD * This permit is only valid after verification from the O.T.LS.D. that a conforming sewage system will be installed to service this lot contact Rollie Mann at 864-5533.'Existing Dweiling to be removed before. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Ft. X ^ ^ CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension Ft. x Outside Dimension _n Ft."Ft." Ft. X Ft." Sq. Ft. ‘ Setback to Lotline Setback to Right of Way ^ Setback to Ordinary Fligh Water Level ^ Ft. Elevation Above Ordinary High Water Level ^ Setback to Septic Tank Setback to Drainfield * Setback to Bluff Maximum Proposed Height Basement______ Walkout Basement Total Bedrooms__ 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 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_____ Ft.&Ft."Ft.&Ft."Ft.&Ft."Ft."Ft."Ft." Ft.Ft.Ft. Ft.Ft.Ft. Ft.Ft.Ft. Ft.Ft. Ft.Ft. Ft.Ft.Yes Ft. Maximum Proposed Height ( ) Boathouse ( ) Gazebo "Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / Inspection Ft.Yes No 77 ( ) Screen Porch ( ) Storage Structure Topographical Alteration / Earthmoving '^■€1 None □ 20 Cubic Yards or Less ' □ 21 Cubic Yards - 299 Cubic Yards' ' Must include on scale drawing Permit may be required□ 300 Cubic Yards or More' CHARACTERISTICS OF LOT: L'3'l ___Sq. Ft.7 Yes NoLot Area.Water Frontage Ft.Bluff Impervious Surface Ratio:Xioo =.%Total Impervious Surface Onsite (FT')Total Lot Area (FT')Impenrious 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 thaf 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 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 footings have been constructed. 3 .....' ^ VDate: /> -y- ovDate: Land & Resource Management Office7 s-^V371 i27l^bPROJECT(S) TOTAL SQ.FT.,PERMIT FEE $RECEIPT NO. Comments: Form No. BK — 1003-0501 316,901 • Victor Lundoen Co., Printers • Fergus Falls, Minnesota ( SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Structure Set Back from Ordinary High Water Level Ft.Ft. Ft.Structure Set Back from Top of Bluff Ft. Ft.Structure Set Back from Road Right of Way o5r'<;^Unl^ Ft. &Structure Set Back from Lot Lines Ft.&Ft.Ft. Structure Height -i-IO Ft. Structure Set Back from Septic Tank Ft.Ft. Ft.Structure Set Back from Drainfield Ft.+ 2o Elevation Of Lowest Floor Above Ordinary High Water Level Ft.Ft.S- JO Land Slope at Building Site %%4 ^ Inspector’s Comments / Sketch: IV 4 5V & Inspector's Signature Date of Inspection Time of Inspection Project Approved Date/Initial I 171.67 86’00'00 BASHET BALL COUBT 7 Be ar ing s s NON PEBNANENr S TRUE TUBES \ \ A'jT* 1 ', JB ! V E <5>I|fc;55j «i» ^ BUILD INN _Lii Vi f X! y t nr LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218)739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMITWHITE-Office - ’ GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor RECEfVED 1 7 2002 land & RESOURCE PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE / RIVER NO.LAKE/RIVER NAME SECTIONLAKE/RIVER CLASS TWP NO,RANGE TWP NAME &J^ Ii^ACCa} l/Zfiu /cef “MitfTiu ‘ SCr L'. ef- A U cf- * (* rrt,^ , iJ ^ (P Pin/ ti tint /?/, lY PARCEL NUMBER (S)E-911 ADDRESS K -^Sccct T\CE U cc i-SCS'S LEGAL DESCRIPTION Last Name First Initial Mailing Address Daytime Phone No. -J ^^ £iJ/l^cn //'a</ /a^ ScS:/\ Property Owner Contractor Lie.# PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add'n to Dwelling (5 ) RCU/Year______ (8 ) Storage Structure (9 ) W.O.A.S. _ 'Existing Dwelling to be removed before__ ONSITE WATER SUPPLY (j^lndividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM(1 ) New Dwelling (4) MH/YR (7) Add'n To Non-Dwelling (10) Other ( 3 ) 'Replacement Dwelling (6/Detached Garag^( ) Permit No. (Xj OTLSD * This permit is only valid after verifeation from the O.T.L.S.D. that a conforming sewage system will be installed to service this lot contact Rottie Mann at 864-5533. CHARACTERISTICS OF PROPOSED DWELLING CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension Setback to Lotline Setback to Right of Way /t/ Setback to Ordinary High Water Level .S'SO * Ft. Elevation Above Ordinary High Water Level ^ Setback to Septic Tank _j^ If Setback to Drainfield Setback to Bluff Maximum Proposed Height Bathroom Proposed ( ) Yes (\4) Nn CHATIACTERISTICS OF PROPOSED W.O.A.S. (WATER^ENTED ACCESSORY STRUCTURE) ft. & _ -It/ - Ft. Outside Dimension ___ Setback to LotliiX, Setback to Right of Setback to Ordinary HiglyWater Level y Elevation Above Ordinary ^h Watgp«vel Setback to Septic Tank , ^ Setback to Drainfield ^ ~N^t. Setback to Bluff / Maximum Proposejjrfleight Basement X Walkout Sapient Total Bedrooms__ Ft."Ft. X Ft. X ..y Outside Dimension_____ Setback to Lotline Ft.&FW t. XFt.”Ft.Ft." Ft. Setback to Right of Way Ft.(/ Setback to Ordinary Hig Ft." Ft. later Lew __ Elevation Above Ordj/tSry High Water D^el Setback to SepUdUank Setback to Bfainfield _ SetbacloTO Bluff_____ Ft.Ft. Ft. Ft.Ft. ■I Ft. Yes Ft, yNoYes Ft.'Ma)^um Proposed Height (fi Boathouse ( ) Screen Porch ( ) Storage Structure( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / inspection Topographical Alteration / Earthmoving .» None □ 20 Cubic Yards or Less * ' Must Include on scale drawing Permit may be required□ 21 Cubic Yards • 299 Cubic Yards'□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT: Ju> t Ft.^NoSq. Ft.Lot Area.Water Frontage Bluff .Yes ■ loMMmTotal Lot Area (FT^) Impervious Surface Ratio:Xioo =.% Total Impervious Surface Onsite (FTr)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 shali 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 Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of .aid Ordin^ces. ' I understand that it is my responsibiiity to inform the Land & Re^ouri Managejnet^t office ofce pte bi^flding footings have been constructed. <5^/A - C'Z_ Ijb/M___ '7.‘T.00 Date: fgnaturepi Promacty mer nDate:Ivtihs Land & Resout Bment Office . PERMIT FEE $RECEIPT NO. Comments: AUG 1 ^ ZOOZ LA,A...' Y Form No. BK — 0500-0501 305,576 • Victor Lundeen Co., Printers • Fergus Falls, MN • 1-800-346-4870 7^i•V,'f t'. *wh;te - ortwk GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor "V.APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218)739-2271 • FERGUS FALLS, MN 56537 -i '^' 7 C Permit No.PLEASE PRINT OR TYPE ALL INFORMATION A. LAKE / RIVER NO.LAKE/RIVER NAME SECTIONLAKE/RIVER CLASS RANGETWPNO.TWP NAME / ^ 6/0 ■i APARCEL NUMBER (S)E-911 ADDRESS ■■i 35SS^ iOa.C^l/ kfix/ /pf/ ^rr/eK ^Sr(j t :^£,j) 1/cc 2- legal description , CoiJ 'T^tfSH/e /yj, t/t ' /J.~t 2S ' F. «(■ XbJ Ctrnt, ^hi- aJ d-‘ Ay/h* L,r,f b^x V .. d> ' j-'T, A a 77s7 initial I falling Address^ ■ ^ f ■ I /?/ 7\T 1Last Name Daytime Phone No. liJ/l ^f/7 ,'/ /t! £^y77/f Mr£ sc \ Property Owner Cl\KiS>f)K}8i.¥- 9H9 1 f•v Contractor Lie.# ■I VXi__ PROPOSED PROJECT (please circle the appropriate number) (2) Add'n to Dwelling ( 5) RCU/Year_____ (7) Add’n To Non-Dwelling (8 ) Storage Structure (10) Other. ONSITE WATER SUPPLY Cx) Individual { ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a welL ONSITE SEWAGE TREATMENT SYSTEM V (1) New Dwelling (4) MH/YR____ ( 3 ) 'Replacement Dwelling (6 j^BeSchid Garag^ (9) W.O.A.S. ( ) Permit No._______ (A) OTLSD * This permit is only valid alter verification from the O.T.LS.D, that a conforming sewage system wilt be installed to service this lot contact Rollie Mann at 864-5533. 1 'Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension ^ Ft. x Setback to Lotline Setback to Right of Way Setback to Ordinary High Water Level > Elevation Above Ordinary fhgh Watej-Cwel Setback to Septic Tank r^ '^ Ft. Setback to Drainfield /7Jr' Vt. Setback to Bluff Z' Maximum Propose^MHeight Basement / Yes Walkout Basement_____ Total Bejffooms_______ CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension Setback to Lotline Setback to Right of Way Ft.'l-: Setback to Ordinary High Water Level SSO ^Ft. Elevation Above Ordinary High Water Level Setback to Septic Tank Ft. )/ Setback to Drainfield 7 Setback to Bluff Maximum Proposed Height Bathroom Proposed ( ) Yes ( V^LNo </ CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)3 ^R." i?g7 Ft." ‘^7^ R.XFt."Outside Dimension____ Setback to Lotline Ft.&\Ft:"R(^x -Ft.'*,X- Ft. &.x_ Setback to Right of Way \_Ft." Setback to Ordinary High Water Le\)el __ Elevation Above Ordinary High Water twel Setback to Septic Tank Setback to Drainfield _ Setback to Bluff Ft."Ft. r Ft, Ft. Ft.Ft. Ft.Ft. Ft.Ft.■* Yes No Maximum Proposed Height ( .) Boathouse ( ) Screen Porch ( ) Storage Structure Ft. m( ) Gazebo **Proiect/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection ' ^ — %a ■‘:d Topographical Alteration / Earthmovinq .& None □ 20 Cubic Yards or Less ' □ 21 Cubic Yards - 299 Cubic Yards' ' Must include on scale drawing Permit may be required□ 300 Cubic Yards or More'1-25CHARACTERISTICS OF LOT: I.Yes ^ NoFt.Lot Area.—Sq. Ft. -X-r.-*- r"? 7Gg "i" Total Impervious Surface Onsite (FT') Water Frontage Bluff '4 ■ //.- fey Total Lot Area (FT') Impervious Surface Ratio:X100 =.% Impenrious 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 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. I understand that it is my responsibility to inform the Land & Resource Management office once ^e building footings have been constructed. £3^Date:r ^nature of Property Ovmern(% to OZDate; Land & Resource Management Office • / C.n//6. t-CPERMIT FEE $RECEIPT NO. Comments: Form No. BK — 0500-0501 305,576 • Victor Lundeen Co.. Printers • Fergus Falls, MN • 1-600-346-4870 ---- r -A.. SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations *yh $"fv imAi m— Structure Set Back from Ordinary High Water Level Ft. Ft./Oc? Structure Set Back from Top of Bluff Ft.Ft. 2^^Structure Set Back from Road Right of Way Ft.Ft. Ft. &Structure Set Back from Lot Lines Ft.Ft.Ft.& Structure Height 5 Ft.Ft. Structure Set Back from Septic Tank Ft.Ft. 25Structure Set Back from Drainfield Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level Ft.Ft. Land Slope at Building Site %% lacInspector’s Comments / Sketch: 2-(tjO 1I I t n !/r?, I- f SJ -iN &I' ^Wvt Inspector's Signature1Date of Inspection Time of Inspection /O Project Approved Date/Initial 1% .inch(es) equals feet.grid(s) equals feet, orScale: RECEIVED Please use this sheet for the required scale drawing of your proposal. Be sure to include lot dh^Bn^oh, ^^ler frontage, and setbacks from RW, lake, lot lines, sewage system, top of bluff, existing structures and all imper vious surface.LAND & RESOURCE Required impervious surface coverage calculation (See definition in Shoreland Management Ordinance) Total Lot Area (FT2) X 100 =% Total Impervious Surface Onsite (FT2) 7J-"7S •UZLA.A.ilt'' I'1 4cs i ^ ’'%\ \n>\w f V i ~-M I' ■ >tt fjf' *r I :• r f ,)i Vi <b tV VW4 >\ AJ fI5 f e> I I !iX tiV^rr ^\l' !» AUG 1 /: 2002 CT LAND S F ESl'L'RCE ft Dated M' BK-^ /j f signaturetisoo ^029 304.678 • Victor Lijndeer> Co., Printers • Fergus Falls, MN • t-800-346-4870 u WHITE-Office GOLDENROD - Inspector YELLOW - Owner PINK - Assessor LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMIT lliL90Permit No.LEGAL DESCRIPTION BLUFF ZONEAND 7 □ YES rXNQ LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME O/fzUtl-LS 6^/33&V PARCEL NUMBER (S)GRADING / FILLING □ YES # OF CUBIC YARDS ^ NO FIRE NUMBER oa//L' 3.U i IDENTIFICATION: Please Print All Information TELEPHONE NO. L3grHame_________________^irst_______Initial Mailing Address — No.^Street, City, State, and Zip Code (Daytime) Property Owner fr^tP/,1 /^^jJSTfZuCTCnkiNamContractor State Lie. # PROPOSED PROJECT ^ New Structure(s) ( ) Addition{s) ( )MH/RV______________ PROPOSED USE ^ Dwelling ( ) Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS) 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 jj^lndividual Permit #_____ ( ) Collector Permit #_____ OTLSDYEAR CHARACTERISTICS OF DWELLING ( ) Dwelling C^IARACTERISTICS OF NON-DWELLING ( ) Utility Structure CHARACTERISTICS OF WOAS ( Tfetached Garage ) Boathouse ( ) Screen Porch ^ Replacement Dwelling ( ) Addition to Dwelling ( ) Attached Garage (;<46<t9ling Dwelling shall be removed on or beforej2$!J^/\ ( )Gaz(( ) Utility Structure( ) Other side Ft. X .Ft.( ) Other, Outside Dimension Outside Dimension Ft. X .Ft.Lotline Setbacks ,Ft.&Ft..Ft.X/O F./O Ft XLotline Setbacks OHWL Setback .Ft. Lotline Setbacks Ft.&Ft. OHWL Setback .Ft.Bathroom: ( )Yes (\^)No (If Yes / a complying Sewag^ystem Required)OHWL Setback .Ft.Total Bedrooms Maximum HeigM^S Ft. (2 story)Maximum Height Ft.Maximum Height /10 ft. (1 story)story ZLot Area .Sq. Ft. impervious Surface .Sq. Ft.Impervious Surface Ratio .% 3Water Frontage Ft. Elevation of lowest floor above OHWL Ft. (3’ minimum) Structure setback to right-of-way_________ Structure setback to septic tank_________ Dwelling setback to Soil Absorption System Ft. Slope of lot .% /o .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). Ao 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 ordin^es. I understand that it is my responsibiiity to inform the Land & Resounre Management of|iee^nce the building footings have been constructed. * This permit is only valid after verification from the O. T.L.SD. that a conprming^ewagd'^lsferrtwill he instead to service this lot... Contact Rollie Mann at 864-5533. S/J. V / ft 5/? i/‘A 7 6d'00 %Dated: Dated; ar\6&oorce Management Office PERMIT FEE $RECEIPT NO. Comments: Form No. BK — 0597-002 290.621 • Victor Lurtdeen Co . Printers ■ Fergus Falls. MN ■ 1-800-346-4870 t APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 • FERGUS FALLS. MN 56537 WHITE - Office GOLDENROD - Inspector YELLOW-Owner PINK - Assessor i Permit No.LEGAL DESCRIPTION k l'(f ill)'/, OcJu BLUFF ZONE'1AND 4'□ YES [3, NO /LOCATION LAKE NUMBER LAKE/HIVER NAME LAKE/RIVER CLASS _ SECTION TWP NO.RANGE TWP NAME ^ u PARCEL NUMBER (S)GRADING / FILLING □ YES # OF CUBIC YARDS □ NO FIRE NUMBER r^// G/a IDENTIFICATION: Please Print All Information TELEPHONE NO. Last Name First Initial Mailing Address — No. Street, City, State, and Zip Code (Daytime) Property Owner J I r '/ ^TkluCTtrkINameContractor JState Lie. # PROPOSED PROJECT (^) New Structure(s) ( ) Addltion(s) ( )MH/RV___________ PROPOSED USE ^ Dwelling ( ) Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS) ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Ctipt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM Individual Permit # ( ) Collector Permit #. X".YEAR (/) OTLSD */ CHARACTERISTICS OF NON-DWELLING ( )' Qptached Garage CHARACTERISTICS OF DWELLING Basement^— Replacement Dwelling :^) Walkout ( ) Addition to Dwelling ( ) Attached Garage ^ ^ (-) Existing Dwelling shall be removed on or beforeG'V f\ ^ '^'^^sion CHARACTERISTICS OF WOAS ( ) Utility Structure ( ) Boathouse( ) Dwelling ( ) Screen Porch ( ) Gazebo ( ) Utility Structure( ) Other i \\Ft. X .Ft.( ) Other Outside Dimension Outside Dimension. f .Ft. X .Ft.Lotline Setbacks .Ft.&.Ft.Ft/O Ft.Lotline Setbacks Ft.&OHWL Setback Bathroom: ( ) Yes (If Yes / a complying Sewage'^stem Required) story .Ft..R.Lotline Setbacks .Ft.& OHWL Setback .Ft.)No OHWL Setback .Ft.Total Bedrooms Maximum HelghtYSS Ft.'(2 story) ,y \ Maximum Height Ft..Maximum Height /10 ft. (1 story) zLot Area .Sq. Ft. impervious Surface impervious Surface Ratio.Sq. Ft..% Water Frontage .Ft. Elevation of lowest floor above OHWL Ft. (3’ minimum)V.- Structure setback to right-of-way____________ Structure setback to septic tank_____________ Dwelling setback to Soil Absorption System__ Non dwelling setback to Soil Absorption System Ft. Slope of lot .% .Ft. (10’minimum) (Sewage System Permit required before installation). Ft. (20’minimum) (Sewage System Permit required before installation). /k/kr-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 responsibiiity to inform the Land & Resource Management office once the building footings have been constructed. * This permit is oniy vaiid after verification from the O.T.L.SD. that a conforming sewage system wiii be instalied to service this iot... Contact Rollie Mann at 864-5533. Dated:------7^T Signature 6t Ov^er 1,Dated: —& Resource Management Office ■ I'O l'/PERMIT FEES RECEIPT NO.-2 Comments: Form No. BK — 0597-002 290.821 • Victor Lundeen Co. Printers • Fergus Fells. MN • 1-800-346’A870 INSPECTION RESULTS Make all measurements and computations Structure Set Back from Ordinary High Water Level Ft.Ft. Structure set Back from Top of Bluff Ft.Ft. 3SStructure Set Back from Road Right of Way Ft.Ft. ^>3Structure set Back from Lot Lines ,Ft.&Ft.Ft.&Ft. Structure Height Ft. Ft.T ■O' Structure Set Back from Septic Tank So Ft.Ft. Structure Set Back from Absorption System Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level____________________3-V Ft.Ft. Land Slope at Building Line % % b r Mx.1/Inspector’s Comments / Sketch:, -I — r /o}. !,S’ V I Sd.io't- k O Inspectar's Signature Dale of ln^)ectk>n Time of Inspection GRID PLOT PLAN feet SKETCHING FORMIinch(es) equals.grid(s) equals• Scale:feet, or. nDated:, 19 Signature Please sketch your lot indicating setbacks from road right-of-way, lake, sideyard and septic tank and drain- field for each building currently on lot and any proposed structures. I - \ ! ;I I t- \ |o i]---!i i.I cI I*4I vj Os « Ov , Q tv CX I I 1 -----u _! ^ >: ^I V4 ^'A 1!i *Ii-1 AiIi-KIiXii7 11 %Al i Ioo t.\;iC~!If I ■/I ill.;j ; -3*:t i : i I I I 1 i 1- * i 281,949 • ViClOf LundMn Co, Winters • Fergus FaJIs. MN • t-800-346-4870MKL — 0871 — 029 White — Office Yellow — Owner Pink — Assessor Goldenrod — Inspector SHOREL'AND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY Permit No„LEGAL Date,DESCRIPTION AND K IcL^diLOCATION 5, )35 M G. Qj^s. Lake No.Lake Name Lake Classif.Sec,TWP TWP NameRange IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address— No. Street. City and State Zip No.Tel. No. /?. ^LOwner SattrU TfaJbLT NameContractor Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE:St^Building ( ) Alteration ( ) Other ( ) One Family Dwelling ( ) Multiple Dwelling (i^^^ther Specify: miUnits r^ j-f- ^Size ESTIMATED COST OF IMPROVEMENT $ .(omit cents) PRINCIPAL TYPE OF FRAME;TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry ( ) Wood Frame (^>+fltfuctural Steel { ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public ( ) Individual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central Basement: ( ) Yes ( ) No Stories above basement: Sq. feet (outside dimension) Bedrooms Baths HEATING: t ) Electric ( ) Gas ( ) Coal Other: Type of Roof:( ) No ( ) Oil ( ) No ( ) None ( ) Unit CHARACTERISTICS: )Y S^ Od 6Lot Area is square feet.Water frontage is feet. (Building Line) feet feet. V6 ^Building set back from high water mark is Land height above high water mark at building line is Building set back from State highway is........................ Side yard is Building will be located Building will be located LzAq. 2c.feet — from road or street is feet. la.and feet. Rear yard is feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.). feet. 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. -X.Signature^w^^wner Dated. Permit: 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. ^ Permission is hereby granted to the above named applicant to perform the work described ii he above statement. This permit is granted upon the Shoreland Management Official 3 7PDated Permit Fee $ o?. OO State Surcharge S / Comments: Form No. MKL-0771-002 VICTOa UINOKN A eS.. PKlHTEftt. fCIIAuS FM.LS. HINN 158899