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Vierzba Family Cluster_53000320250000_Shoreland Permits_
WHITE - Office ' 'APPLICATION FOR SITE PERMIT GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME >2, ^35" J*?0 Cs?^0 PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS LAHA/t^Z-0 oo- 0 - Ooo LEGAL DESCRIPTION f^T. C'TY J-fff Last Name First Initial Mailing Address Daytime Phone No. ^yyvru. ^3^1 Property Owner Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling (4 ) MHA'R ( 7 ) Add’n To Non-Dwelling not Other ONSITE WATER SUPPLY ) Individual ( ) Public NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYST^ . .( ) Permit No. .S fe' / T CQ AT^ ^( 2 ) Add'n to Dwelling (fTTyCU/Year^____ ( 8 ) Storage Structure ‘Existing Dwelling to be removed before. (3) 'Replacement Dwelling ( 6) Detached Garage (9) W.O.A.S. ( ) None ( ) OTLSD * This permit is only valid alter verilication from the 0. T.LS.D. that a conforming sew age system will be Installed to service this lot contact Rollie Mann at 864-5533. CHARACTERISTICS OF PROPOS^W.O.A.S. (WATER ORIENTED ACCESS09y‘STRUCTURE)O^side Dimension CHARACTERISTICS OF PROPOSED DWELLING CHARACTERISTICS OF PROPOSED NON-DW^NG // ' Outside \ / Ft. X Ft.” <4 ^ Dimension TiM v>hl' 5j^fe^2SdS- — Ft. & — Ft." Setback to Lotline \ Setback to Right of Wi Setback to Ordinary High'V(ater^vel __ Elevation Above Ordinary Hia^ater Level Setback to Septic Tank / Setback to Drainfiely Setback to Bluff/^_____ Maximum Prosed Height Roof Ch^e ( ) Yes ( ) No Battuwm Proposed ( ) Yes ( ) No utside imension Ft. X Ft.” Ft. X Ft.” Sq. Ft. Setback to Lotline Setback to Right of Way 2e3 Ft.” Setback to Ordinary High Water Level > Ft. Elevation Above Ordinary High Water Level 3 Setback to Septic Tank <0 Ft. Setback to Drainfield Ft. Setback to Bluff Sq.Ft.&Ft.”Setbacidto Lotline_ Setback t^&ght of W Setback to Orliinazy High Water Level __ Elevation Aboxe^dinary High Water Level Setback W^eptic T^ SetbpCT to Drainfield _ S^ack to Bluff____ Ft.&Ft.” Ft.”Ft.” Ft.Ft.Ft. Ft.Ft. Ft.Ft.n Ft.Ft> Ft.Total Bedrooms Maximum Proposed Height -3S~ Ft. Roof Change ( ) Yes (^^ No Basement ( )Yes ()^No Walkout Basement ( ) Yes (^^ No Ft.Ft. Ft. Maximum Proposed Height ( ) Boathouse ( ) Gazebo Ft. ( ) ScreehsPorch ( ) Storage ^ucture **Pro)ect/Lotllnes/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ttyographical 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* CHARACTERISTICS OFXOT:IlorJK42.-C,Sq. Ft.Lot Area.Water Frontage Ft.Bluff ( ) Yes ( y) No ‘A A MUES.Impervious Surface Ratio:xioo =.%Total Impenfious 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 con dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed. Date: Signature of Property 0\ /O-f;Date:/-V C LarfiA IMloQlPROJECT(S)TO''ERMT RECEIPT NO. . A/ul A Tl4iUr TT ^ Th f^trV 'S ID/V iTHiS 7V6-Svt chA/iTS oAfAAy McT yiMK,. nil So Y2Cu's Jl '^ f£>TuJiH%^TWcy £>£Y **n*A^ 5^1^43 pz. A^o ypr 7'x ^.'1 Comments: Form No. BK — 1003-0505 322.179 • Victor Lundeen Co., Printers • Fergus Fails, Minnesota (I, WHITE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us PLEASE PRINT OR TYPE ALL INFORMATION Permit No. SECTION TWPNO.LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS RANGE TWP NAME *0 ^ 1/<9 PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS ^Z-OoO' o:i^o-Ooo LEGAL DESCRIPTION ^2- ^ First*.Mailing AddressLast Name Initial Daytime Phone No. ~TProperty Owner Contractor Name Lie.* PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add’n to Dwelling ( 3 ) 'Replacement Dwelling ( 5 ) RCUA'ear,____ ( 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 SYSTEM(1 ) New Dwelling (4 ) MHA'R____( ) Permit No. ( ) OTLSD * This permit is oniy valid alter verification from the 0. T.LS.D. that a conforming sew age system will be installed to service this lot contact Roltie Mann at 864-5533. ( 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 DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension \Ft.x Ft.” ^4 iA Ft.x Ft." Ft. X Ft."\ Sq. Ft. Setback to Lotline Ft. & SO Ft." Setback to Right of Way 2^ Ft." Setback to Ordinary High Water Level ‘ C30 Ft. Elevation Above Ordinary High Water Level 3 Setback to Septic Tank I CD Ft. Setback to Drainfield DyC Ft. Setback to Bluff Total Bedrooms Maximum Proposed Height -3 S' Ft. Roof Change! )Yes (^ No Basement ( ) Yes ^) No Walkout Basement ( ) Yes {No Sq.Ft Setback to Lotline___ Setback to Right of Way Setback to Ordinary High Water Level __ Elevation Above Ordinary High Water Level Setback to Septic Tank__ Setback to Drainfield_^ Setback to Bluff_______ Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Setback to Lotline Setback to Right of W^ Ft.&Ft."X Ft.&Ft." Ft."Ft.” Setback to Ordinary High V\^t^ Elevation Above Ordinary High.Water Level \ Ft. evel Ft.Ft. Ft. Setback to Septic Tank Setback to Drainfiel^ Setback to Bluff/ Maximum P Roof Change ( ) Yes ( ) No Bathroom Proposed ( ) Yes ( ) No Ft. PA Ft.Ft. Ft.Ft. Ft. V Ft. ( ) Screen Porch ( ) Storage Structure Topooraphical Alteration / Earthmovinq □ None * Must include on scale drawing Permit may be required V-J □ 20 Cubic Yards or Less '□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More' CHARACTERISTICS OF LOT; I Lot Area. Sq. Ft.Water Frontage .Ft.Bluff ( )Yes ( )No 1.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 that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed. Date; Signature of Property Owner Date: e Management Office PROJECT(S) TOTAL SQ.RECEIPT NO. Comments: iForm No. BK — 1003-0505 322,179 • 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 0<J Ft.Ft.Structure Set Back from Top of Bluff Ft.Structure Set Back from Road Right of Way Ft. Ft. & Ft.Ft.Ft.&Structure Set Back from Lot Lines Ft.r Ft.Structure Height Ft.Ft.Structure Set Back from Septic Tank Ft.Ft.Structure Set Back from Drainfield 4Elevation Of Lowest Floor Above Ordinary High Water Level____________________Ft.Ft. Land Slope at Building Site %% c\ ^ CXiInspector’s Comments / Sketch: -if ^-*0 (ikS Inspector’s Signature ,'0-47 'O'T Date of Inspection Time of Inspection ^Project Approved {•» Date/Initial ♦ ■' ■» Print Key Output Page 1 10/26/05 11:18:195722SS1 V5R3M0 040528 OTTER Display Device User ....QPADEV0018JTHOMPSO: RCB310M1 RECAP Collection System R 53000320250000Calc thru: 10/26/2005 Inquiry - General Summary (A)R 2006 Mod? Taxpayer MP# :Total: EMV 235,900Dist: 5301 TIE Dist: Plat :Sect 131391 SHAWN VIERZBA ET AL Deeded acres 42.60LMV92,400 Twnshp Range 039PART GOV'T LOTS 1, 2 & 3 COM NW COR GL 1 E 1329.31' TO BG E NON-HSTD BlockLotAlternate131390 MICHAEL J VIERZBA Escrow 32 135 Subd:GA Exists *MORE♦MORE AGRICULTURALProp Address41488 LONG LAKE RD OTTERTAIL MN 56571-Original Adj/Chg Unpaid BalTPaymentsNet Tax Special Asmt Tot before P&I Penalty Interest Fees* *TotalsF2=Tier F14=Legal F16=Notes F17=APINs F19=OtherNames F24=MoreKeys A=GS B=ASM C=DQ E=TR F=SP H=THST I=PRASC J=COJ P=PA R=ADJ U=CAMA Y=CMP ■* Print Key Output Page 1 10/26/05 11:18:245722SS1 V5R3M0 040528 OTTER Display Device User ....QPADEV0018 JTHOMPSO RECAP Collection System Inquiry - Name Relationships R 53000320250000 : RCB310M4 JTHOMPSO 10/26/2005 11;18;23 R SHAWN VIERZBA ET AL2006PRIMARY TAXPAYERSHAWN VIERZBA ET AL 131391 ALTERNATE TAXPAYER MICHAEL J VIERZBA 1408 ROSEWOOD LN SAUK RAPIDS MN 56379-2910 131390 OWNERJULIE THOMPSON 131392 OWNERTODD VIERZBA 131393 More... F3=Exit F12=Cancel & FILE MEMO PROPERTY OWNER i LAK^RIVER/WETLAND NAME J(''^L :9.IO) PARCEL # 53 OOP 3g? 0^^0 06>0 /mDateL&R OfTidal -f'•ft Action/Comments ___ ^msptA ' /3^wcT Unj^ ^ iipw ^ Date L&R Official Action/Comments. Date L&R Official Action/Comments. T > I L&R OfficialDate Action/Comments. : L&R OfficialDate. Action/Comments. L&R OfficialDate Action/Comments. L&R OfficialDate Action/Comments. Grade & Fill Permit #ns ^i%a± AA \ ^ M v^rPROPERTY OWNER LAKE NO. SEC. TWP. NAME LEGAL DESCRIPTION: pT“ GC /, “Z, ^ . WORK AUTHORIZED t yV jirv;^ ^Y- Wcvjk^ cjj ^ y >~gA\ m**V \yj\VV Vb>^ O^tfcO^ Lq h-o WoJ*-'^ \y-<isfc><i^W V.W Oo\»».Vqv>-<S 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, 218-739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED. CrQO~7oo^ ^ y*UV \ao<*rov< okn^'cVo. ^ <r«»>A ’e^>^ *V’ Vo Vvn*»4*^U. 'r»v4tyC.«*.vw.j^^Vr^3 1. EARTHMOVING SHALL BE DONE BETWEEN & 9- /r-o^ 2 . Entire area shall be stabilized within 10 days of completion of any earthmoving. 3.. Owner is legally respon»|^e for all surface water drainage that may occur. 4„ No fill shall enter or be taken from the beds of public water without a valid permit from the MN Department of Natural Resources. 5. if the terms of this permit are violated, the entire permit may be revoked and the owner may be subject t'6 legal prosecution. fi. .FroRinn r*r»nt*:o>•••• • •X L.'- ! W^Cv- fsj V-'v^^W* V) y- ^>>1 VT^^'- V“ v-^ Ua'^^ <^>V. It^ W'(X Cf received AUG 03Z005 LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER ^ Resource GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 GRADE & FILL APPLICATION■ I' www.co.otter-tail.mn.us PERMIT NO.Application Fee Receipt Number 37 W PROPERTY OWNER /n ( W ^ iHoyMAILING ADDRESS CITY, STATE, ZIP - co^7 LAKE NO. SL^-'T-iO CLASS RO DAYTIME PHONE NUMBER LAKE NAME k 0 nJ LA-)L/r PARCEL NUMBER (S) A ^3 3 :Xn X <T) Oo n SECTION TWP / RANGE TWP NAME Rw 5 t-i- U¥\lf7 LEGAL DESCRIPTION Uw'r u-ri i. 2, ^ c^'Z CL /■! /3^-3,'TP <2, h. s /g yV' rd uh<^ u>iLy tz> !<rcz ' ______________________________________ /VE-911 PROPERTY ADDRESS 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. Received L&R Official DATE PROJECT REQUEST (provide the scale drawing on back): /2^maximum depth OF CUT:FT. MAXIMUM DEPTH OF FILL: FT. YDS^TOTAL CUBIC YARDS OF EARTHMOVING REQUESTED: 2 2o TV 2^0 DESCRIBE YOUR PROJECT BELOW: Af/<4 TD /Sini^o R&4 0 Shl, unOi(. V\c.iru<r^ OF' Tth^A/S>-h/0 f^o/^ COAJT/r^lTf/oC ^ £> uyt^ Tb TVSr~F^f fZ'i) (p/i Or FrFrZfn Fl<tLO CcpO'Vcii ft) , lup^ um-t. S/t ^ t^cc4C Si^t.pi/VT prtcFy] ats f. cW' ~n /P "T)i-A'T ip I r>A s/hwo prUF^t^Zjy OF PP . X ^ ^ FliCfz TV Tfh yv v4-F^c4 orJS uy /h^i^TLoyri^ -rTL^Ui^ C-F*Ty^(~\!0 C.Pr/vnJ) 7"0 ooF~ /Zjt/hO iH cM- yV/Syfr2_ Oph*~T-‘//''C ~ uJo'OuO F>fz, PcF~^^nwii-^Ti-TZPc^ n.Doc^L'y I. (--o .e 5 Trhripin/C,//C iUi Ayp// nHs A'^-xyrM fpFfTFs /:fTZJc F^nplKk^ paJ O ^ ^TTV-CAi-p^yf SCrH-F>0 D<'Zypo>rPC . ItUSIGNATURE OF RROPERTYtoWNER/AGENT FOR OWNER DATE BK — 0505 322,369 • Victor Lundeen Co Printers • Fergus Falls, MN • 1-800-346-4870 ■:* m mW •'■fr- r-^ ^.•jR 5;- ( r RECEIVED SEP 0 9 2004APPLICATION 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 land & RESOURCE Try.Permit No.PLEASE PRINT OR TYPE ALL INFORMATION TWP NAMETWP NO.RANGELAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE / RIVER NO. IS.^10 3 afZo PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) ^ -oOd LEGAL DESCRIPTION Daytime Phone No.First Initial Mailing AddressLast Name Property Owner Contractor Name Lie.# 5 4L^l,f ONSITE WATER SUPPLY ( ) Individual ( ) Public 1^ None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM PROPOSED PROJECT (please circle the appropriate number) (2 ) Add’n to Dwelling (5 ) RCU/Year_____ (7 ) Add’n To Non-Dwelling ( 8 ) Storage Structure ^t^^ew Dwelling (3 ) *Replacement Dwelling (6 ) Detached Garage (9) W.O.A.S. ( ) Permit No. ( ) OTLSD * This permit is only valid alter verification from the O.TLS.D. that a conforming sewage system will be installed to service this lot contact Ftollie Mann at 864-5533. (4) MH/YR. ^^Other 'O^e/Cyi lling to be removed before CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSffl-MOM DWEmNGOutside r\0 O Dimension (4 Ft. x Sq. Ft. I iX- Setback to Lotline 4#^ do Ft. & Uo Ft." Setback to Right of Way Ft.'* Setback to Ordinary High Water Level Ft. Elevation Above Ordinary High Water Level ^ Setback to Septic Tank — Ft. Setback to Drainfield Setback to Bluff Maximum Proposed Height ? Ft. Bathroom Proposed { ) Yes (X) No CHARACTERISTICS OF PROPOSED DWELLINGOutside Dimension Sq. Ft. Setback to Lotline (H* 4. ^ i&Q^t." Setback to Right of Way A-f HstO Ft." Setback to Ordinary High 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 3* Ft. X Ft." Ft. X Ft."P 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 Ft.&Ft." Ft." 3 Ft.Ft. Ft.Ft.Ft. -----Ft.Ft. Ft.----- Ft.Ft.5__Ft.Ft.Ft.y NoYes Ft.NoYes I ( ) Screen Porch ( ) Storage StructurePt Ci<SrtA.LW«H\ "Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection O Mfet*l?iclu«feftt4cale drawing Permit may be required21 Cubic Yards<^99^,8f(^c Yards' □ 300 Cubic Yards or More' Topographical Alteration / Earthmoving 0 Cubic Yards or Less ' □ CHARACTERISTICS OF LOT: Yes Y NoSq. Ft.BluffLot Area.Water Frontage Ft. ^ ZS-Impervious 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 pians 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 appiicant 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 responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed. SignaturefifwPjfo^rty O^er >1 p Date: Date: O^ _ Land rS Resource Management Office ^-h/<? L PERMIT FEE $/7 7S-/JPROJECT(S) TOTAL SQ. FT.RECEIPT NO. Srtrh^Oy—77? ’TTZ/F-/iZiZcP. Comments: Form No. BK — 1003-0501 315,901 • Victor Lurtdeen Co., Printers * Fergus Falls, Minnesota <0/CAPPLICATION FOR SITE PERMITVW.'7E - GOLDENROJ - Inspector YELLOW - Owner (after issue) PINK - Assessor LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us -I I EXPIREDPLEASE PRINT OR TYPE ALL INFORMATION TWPNAMESECTIONTWP NO.RANGELAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO.V- 13^I 0 5^do -.5- PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)aj /\- 3:^ 6^-OOP k LEGAL DESCRIPTION ^ ^ t .r - -•;•4 fr Ooy Daytime Phone No.First Initial Mailing AddressLast Name /*UCM44i/. SProperty Owner SfHJlC m^J.I Contractor Name Lie.# ^4 L.f 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 PROPOSED PROJECT (please circle the appropriate number) (2 ) Add'n to Dwelling (5) RCUA'ear. hT"' 's.'(1) New Dwelling f 4) MH/YR (7) Add’n To Non-Dwelling (8 ) Storage Structure (lb tother T. \L : tExistmg Dwelling to be removed before (3) ‘Replacement Dwelling (6) Detached Garage (9) W.O.A.S. ( ) Permit No. ( ) OTLSD * Vnis permit is only valid alter verification from the O.T.LS.D. that a conforming semge system will be installed to service this tot contact Rollie Mann at 864-5533. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside 'Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside .. Dimension 4 Ft, x D L* Ft.” Sq. Ft. A ^ii % Setback to Lotline a A C oQ^\. & /4rf_^_2|^t.” Setback to Right of Way 4^ foeo Ft.” Setback to Ordinary High Water Level // O Ft. Elevation Above Ordinary High Water Level 3 Ft. Setback to Septic Tank Setback to Drainfield — Ft. Setback to Bluff Maximum Proposed Height ^ Ft. Basement_____ Walkout Basement Total Bedrooms_ diXk.L\U‘M{l\ CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension N J .• ) Ft.”Ft. XPSq. Ft. / 'L Setback to Lotline -ir- Ft. & Oo Ft.” Setback to Right of Way h-a^v Ft.” Setback to Ordinary High Water Level V Ft. Elevation Above Ordinary High Water Level__^ Setback to Septic Tank Setback to Drainfield _ Setback to Bluff Maximum Proposed Height ? Ft. Bathroom Proposed ( ) Yes (X) 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.H.Ft. ■ 'S*-R.Ft.Yes __No Maximum Proposed Height ( ) Boathouse ( ) Gazebo Ft.)L__NoYes I ( ) Screen Porch ( ) Storage Structureci< **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection y ^ Must include on scale drawing Permit may be required□ 300 Cubic Yards or More* Topographical Alteration / Earthmovinq , ly None 13^20 Cubic Yards or Less * □ 21 Cubic Yards'’^ 299,.Ctibic Yards* CHARACTERISTICS OF LOT: Yes k No.Sq. Ft.Lot Area,Water Frontage .Ft-Bluff Impervious Surface Ratio:z.X100 ==Total Impervious Surface Onsite (FT^)Impervious Surface RatioTotai 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 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 responsibiiity to inform the Land & Resource Management office once the building footings have been constructed. ■ ? H-JtZxL. ,Date: Signature of P^^rty^Jdgrher^^^^y^ -r' Date; Land S Resource Management Office y7 733.4 rv-/<' r PERMIT FEE $PROJECT(S) TOTAL SQ. FT.RECEIPT NO. TJL,d-y i-f,.Comments:v< % A- i <.-mr4Q f . VZ C f rj -T-X ' 77> r /- 4.7,..■rhr ■/‘•f.- % VForm No. BK — 1003-0501 315,901 • Victor Lundeen Co., Printers • Fergus Falle, Minnesota V'SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations So /QO/0(,Ft.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. /(PQ Ft. & /OO'i*-Ft.Ft.&Structure Set Back from Lot Lines Ft. Ge Ft.Ft.Structure Height Ft.Structure Set Back from Septic Tank Ft. o!w Ft.5T0 V-Structure Set Back from Drainfield Ft. Elevation Of Lowest Floor Above Ordinary High Water Level Ft.Ft.7 ^ Land Slope at Building Site %% Inspector’s Comments / Sketch: V o Inspector's Sigi vD- KV v'Date of Inspection Time of Inspection ^^tojoct Approved Date / Initial P2 ll±l \ DateSignatureScale RECEIVED SEP 0 9 2004 LAND & RESOURCE . ! Ji ! t [ I i I ! i t 4, T T-r^Ait fd _y BK — 0403 313,987 * Victor Lijndeen Co.. Printers • Fergus Falls. MN ♦ 1-800-346-4870 riif\ z m DateSignatuScale RECEIVED SEP 0 9 2004 LAND & RESOURCE i I i ! : ;;! iilC! A ! f / . BK — 0403 313,987 * Victor Lundeen Co.. Printers • Fwgus Falls. MN • 1-800-346-4870 RECiril'Po 2 7 7003 Wl^lTE - dWce GOLDENROD - Inspector APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us YELLOW - Owner (after issue) PINK - Assessor '-’®«ES0URC£ (q (/>PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE / RIVER NO.LAKE/RIVER NAME SECTION TWP NO.LAKE/RIVER CLASS RANGE TWP NAME kO/^G 32P-0 PARCEL NUMBER (S) PROPERTY (E-911) ADDRESS ^^O0 032o ^^Oooo LEGAL DESCRIPTION CO. ai. ni. ec t j' ri.ak a<v 5^'iy A.'M/ rz? ><W 6-4/^s 5. ✓✓ /^z' tv__________________________ Last Name First Mailing AddressInitial Daytime Phone No. jLfo9f 1/^/_________ <0^)1 /hAj. <nv7^ Property Owner X Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) ( 2) Add’n to Dwelling RCUA'ear ONSITE WATER SUPPLY ( ) Individual ( ) Public OC 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 Garage (9) W.O.A.S. ( ) Permit No. ( ) OTLSD * 77>/s permit is ortly vaiid after verifeatim from the O.T.LS.D. that a conforming sewage system will be installed to service this lot contact Rotlie Mann at 864-5533. (y R ©torage Structure ‘Existing Dwelling to be removed before CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED DWELLING Outside Dimensk CHARACTERISTICS OF PROPOSED NON-DWELLING Outside DimensionFt. X 2Gr Ft."iX_Ft.x OutsideDimen^nFt." Ft. X Ft." Sq.Ft._^^ a Setback to Lotline i4k/ Ft. & ^ 'iJtO Sq. Ft. \ Setback to Lotlihe___ Setback to Right oNWay Setback to Ordinary H!i(h Water Level ___ Elevation Above Ordinary High Water Level Setback to Septic Tank__ Setback to Drainfield____ Setback to Bluff_______ Maximum Proposed Height Basement_____ Walkout Basement Total Bedrooms_ So. Ft. \ Setback to Lotllqe ___ Setback to Right obWay Setback to Ordinary Hi^Water Level __ Elevation Above Ordinary 1^ Water Level Setback to Septic Tank Setback to Drainfield _ Setback to Bluff____ Ft.&Ft.”Ft."Ft.&Ft."Ft."Setback to Right of Wa^ Ft." Setback to Ordinary High Water Level (Q^t Ft. Elevation Above Ordinary High Water Level Ft. Setback to Septic Tank Ft. Setback to Drainfield • Ft. Ft.”Ft. Ft.Ft. Ft.Ft. Ft.Ft.FC Setback to Bluff Maximum Proposed Height Bathroom Proposed ( ) Yes (‘^) No Ft.Yes No i^Ft. Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ft.Yes Ip ( ) Screen Porch ( ) Storage Structure 0/C-.5<‘c TVKVtUw- ‘^0'^ '^21 Cubic Yards - 299 Cubic Yards‘ Topographical Alteration / Earthmoving □ None ‘ Must Include on scale drawing Permit may be required20 Cubic Yards or Less *□ 300 Cubic Yards or More‘ CHARACTERISTICS OF LOT: ACSq. Ft.ISJZ^____Ft.Bluff____Yes jTC, NoLot Area.Water Frontage ^32Impervious Surface Ratio:X100 =.%Total Impervious Surface Onsite (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 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 responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed. Date: SignatuTi Date: Land & Rdeource Management^^tfee / S-79^/PROJECT(S) TOTAL SQ.FT.,PERMIT FEE $RECEIPT NO. & Jj} rri.<jr I^^C/T) TO LUA-Lif' /Wlp~UY\/(2 >C TP Cr^-y-rf;? 2^ ^ i,~ll 7~y^r^ _____ Form No. BK — 1003-0501 Comments: UJt.__TD i^UiLo ft/ ^ 315,901 • Victor Lundeen Co., Printers ■ Fergus Falls, Minnesota L_ci<WHIT^'^ dffice ‘ rSOLDE/VROD - 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 ;■ r 1' expired No..1PLEASE PRINT OR TYPE ALL INFORMATION ILAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME I Si'M 32C<Q PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS ' '^f*/r^Yz.s/rcrip^^ 3qo 032o 2Soooo LEGAL DESCRIPTION .pr-,-!zr 6>ov ItATZ /Vhf CtiL QL \ I ^132%^ I ro t UjLy -m S. f'rhn>n /)/ Mailing Address Su)UH!. ILast Name ■iFirst i Initial Daytime Phone No. j* ,t j f^o T I At/_________Property Owner T :^a.o~L^H’UL9 Contractor Name Lie.# I PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add’n to Dwelling ( 5 ) RCU/Year_____ ONSITE WATER SUPPLY ( ) Individual ( ) Public (y ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM A/Onffj, ft-(1) New Dwelling {4) MHA'R (7) Add’n To Non-Dwelling (10) Other__________ ( 3) 'Replacement Dwelling ( 6 ) Detached Garage (9) W.O.A.S. I ( ) Permit No. ( ) OTLSD * 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. i I t ^^torage Structure 'Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimendtpn CHARACTERISTICS OF PROPOSED DWELLINGOutside Dimension Sq. Ft. Setback to Lotiih^ Setback to Right oSWay Setback to Ordinary High Water Level__ Elevation Above Ordinary'Tijqh Water Level Setback to Septic Tank__ V Ft. Setback to Drainfield___ Setback to Bluff_______ Maximum Proposed Height Basement____ Walkout Basement Total Bedrooms CHARACTERISTICS OF PROPOSED NON-DWELLING Outside r Dimension / y Ft. x 12 Ft." Sq. Ft. ,. A{32i Setback to Lotline 4^ -Ldb Ft. & Setback to Right of WavY' Ft." Setback to Ordinary High Water Level f Elevation Above Ordinary High Water Level Ft. Setback to Septic Tank Ft. Setback to Drainfield Ft. Setback to Bluff -ymIa- Ft. Maximum Proposed Height Ft. Bathroom Proposed ( ) Yes (y^) No : ’v-Ft. x Ft." Ft. X Ft."\ Ft."Sq.Ft. ___ Setback to Loblqe___ Setback to Right ^Way. Setback to Ordinary h)^ 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. / ■t.Ft. Ft. Ft.Yes No Maximum Proposed Height ( ) Boathouse ( ) Gazebo "Project/Lotllnes/RIght-of-ways Must be Staked Onsite Prior to Application / Inspection Ft.Yes \( ) Screen Porch ( ) Storage Structure\ oic 5>CTopographical Alteration / Earthmovinq □ None 1^ 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: Aesq. Ft.Lot Area. ‘ fotatll-Of Area (FP) Water Frontage Ft.Bluff .Yes X. No HXl n^h? 'ifU. Impervious Surface Ratio = /. 1.Impervious Surface Ratio:X100 =.%Total Impervious Surface Onsite (FT^j 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 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. Signature of PropertypwnerA yv A.'/^ Land & Resource Management ^ffhe -7 5"- /r: zi -'Q-x »0-5 • •}Date: Date: / i'795 /PROJECT(S) TOTAL SQ. FT..PERMIT FEE $RECEIPT NO. vTtv'O a/,'I I —Du-YT /-f^yvyz.-A<7 7?9 it. S^- >*f4-—rv Comments: Ujj, .-JT2 —£L ___ 2W /». :DtL 'J 7'' if K-.Form No. BK — 1003-0501 315,901 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota A 'A,SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Structure Set Back from Ordinary High Water Level Ft.Ft. Structure Set Back from Top of Bluff Ft.Ft. Structure Set Back from Road Right of Way Ft.Ft. (<^rr- Ft. & tjor- Ft.Ft.Structure Set Back from Lot Lines^^Ft.& Ft.Structure Height Ft. Ft.Structure Set Back from Septic Tank Ft. Ft.Structure Set Back from Drainfield Ft. Elevation Of Lowest Floor Above Ordinary High Water Level 7 Ft.Ft. C)—JLand Slope at Building Site %% A. — u/siX ^Inspector’s Comments / Sketch: /V (■‘<P jt■jJMi ev'i Hh 1 L. too' m■? J Inspector's Signature Date of Inspection Time of Inspection r^-Project Approved ^ // Date/Initial mr j rn-|-i i' 1M \ R'uin R-1-.f1 4 L ■hI.r i;i4Ii II !1I1i |- rrriI)!-t if L Li-LI-t t iI - Ii/ f i": ' C U.})iv^^^y^^Tvi.I.ii[±Qi kt-l” ['/I■■hii [-4.444-I"'-n#ir Sigh^h U-M I j Date- . il_L- . I I.I. ■-! 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T \ «*DateScale f^ECEIVEC 2 7 2003 kOCfiPOo^o/ OfJ Py^^<rf^<l7y land 3l R£SQjfj(;g 1 f>) r §I V s(ti !!UOrJ<i UHtfL fZeA-O„i. ; i \X \f I j pQJ^h,'^- S>V BK <- 0403 313.987 • Victor Lundeen Co.. Printers • Fergus Fells. MN • 1-800-346-4870 LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMITWHITE - Office GOLDENROD - Inspector YELLOW -Owner PINK - Assessor wmt/)A (oL■O'Permit No.LEGAL DESCRIPTION BLUFF ZONEAND □ YES ^SlNO LOCATION RANGESECTIONTWP NO.WP^AMELAKE/RIVERLAKE/RIVER NAMELAKE NUMBER CLA H5 3q 5“3-O0O - 3z - 02SO~ UQO -2iO~£\j GRADING / FILLING □ YES # OF CUBIC YARDS FIRE NUMBERPARCEL NUMBER (S) T2lSio IDENTIFICATION: Please Print All Information TELEPHONE NO. Mailing Address — No. Street. City, State, and Zip Code/U Tf«,M.l/-|z:-n -dr u [vVr\i M n (Daytinie)First Initial ^Last Name \herZ.k ZTK/^uJkuX_2Property Owner ^—f '2M NameContractor State Lie. It ONSITE WATER SUPPLY ( ) individual ( ) Public (X^ NOTE: MN Rules dipt. 4725 (MI<Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM I ( ) Individual Permit» ( ) Collector Permit #____ ( )OTLSD* PROPOSED USE ( ) Dwelling ^4^Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS) PROPOSED PROJECT ^^^ew Structure(s) ( ) Addition(s) ( )MH/RV______________ None YEAR CHARACTERISTICS OF NON-DWELLING ( ) Garage CHARACTERISTICS OF WOASlARACTERISTICS OF DWELLING ( )Boi ( ) Screen PorchUtility Structure luse( )illing ( ) Additibq^to Dwelling ( ) BasemenX ( ) Walkout B^ment Outside N.Dimension__________3 ( ) Gazebo ( ) Utility Structure( ) Other Outside Dimension H .Ft.( ) Other. Outside Dimension Ft. X IQ n.Ft.Ft. X Lotline Setbacks .Ft. la^&.Ft.Lotline Setbacks .Ft.OHWL Setback Lotline Setbacks Ft.&.Ft. Bathroom: ( )Yes (/S^o (If Yes / a complying Sewage System Required) .Ft.OHWL Setback Ft.OHWL Setback Total Bedrooms IAMaximum Height / 35 Ft. (2 story)Maximum Height /10 ft. (1 story)Maximum Height Ft.,story 0 Ac--Z-SSq. Ft. Impervious Surface RatioSq. Ft. Impervious Surface .%Lot Area 3 Ft. (3’ minimum)Ft. Elevation of lowest floor above OHWLWafer Frontage 0(0 Ft. Slope of lot .%Structure setback to right-of-way iQ Ft. (10’minimum) (Sewage System Permit required before installation).Structure setback to septic tank T. (20’minimum) (Sewage System Permit required before installation).Dwelling setback to Soil Absorption System /o Ft. (10’minimum) (Sewage System Permit required before installation).Non dwelling setback to Soil Absorption System TH/S /S A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of said ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. * This permit is only valid after verification from the O.T.L.SD. that a conforming sewage system will be installed to service this lot... Contact Rollie Mann at 864-5533. Dated; Signature of Owner ^ pfh^urce M^f^ement Office f C gDated: 0"Land &a <•«PERMIT FEE $RECEIPT NO.Do 5o rr> cn .Comments: W' ■tTT Form No. BK — 0597-002 287.685 • ViClor Lundeen Co . Printsis • Fergus Falls. MN • 1-8 00-346-4870 APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 WHITE-Office i, GOLDENR&D - Inspector YELLOW - Owner PINK ■ Assessor^ iC ^ iKWlAc.CAl be 11 Z., 3 Permit No.LEGAL DESCRIPTION BLUFF ZONEAND□ YES CT NO LOCATION RANGESECTIONTWP NO.TWP NAME A'b/v LAKE/RIVER CLASSjLAKBRIVER NAMELAKE NUMBER '35 3lD3^ '-3Z- 02SO- OOO ' ^liO /v I GRADING / FILLING □ YES ^tZrNO FIRE NUMBERPARCEL NUMBER (S) ajI -# OF CUBIC YARDS IDENTIFICATION: Please Print All Information TELEPHONE NO. Mailing Address — No. Street, City, State, and Zip Code (Daytime)InitialFirstLast Name /Mi (ka^X\/ierZ-A / Ci? J] C ^ A SSdl I Property Owner 3Mu ; NameContractor f State Lie. # ONSITE SEWAGE TREATMENT SYSTEM, j , ( ) Individual Permit # )\J ( ) Collector Permit #_____ ( )OTLSD* ONSITE WATER SUPPLY ( ) Individuai ( ) Pubiic NOTE: MN Ruies Chpt. 4725 (MN Weil Code) requires a 3’ (minimum) structure setback to a well. PROPOSED USE ( ) Dwelling 3^Non-Dweiiing ( ) Water Oriented Accessory Structure (WOAS) PROPOSED PROJECT ( ) New Structure(s) ( ) Addition(s) ( ) MH/RV____________ |>f None YEAH CHARACTERISTICS OF NON-DWELLING ( ) Garage CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING Utility Structure ( ) Boathouse ( ) Screen Porch( ) Dweiling ( ) Addition to Dweiling ( ) Basement { ) Walkout Basement Outside Dimension ( ) Utiiity Structure( ) Gazebo{ ) Other Outside Dimension ( ) Other. Outside Dimension .Ft. Ft./g_Ft.&.Ft..Ft. X Lotline Setbacks .Ft. kid..Ft.Lotline Setbacks &OHWL Setback .Ft. Lotiine Setbacks .Ft.&.Ft. Bathroom: ( ) Yes (y^ (If Yes / a complying Sewage System Required) .Ft.OHWL Setback No\.Ft.OHWL Setback Total Bedrooms \/1Maximum Height / 35 Ft. (2 story)Maximum Height /10 ft. (1 story)\Ft..Maximum Height .storyt A<^.Sq. Ft. Impervious Surface Ratio.Sq. Ft. Impervious Surface .%Lot Area .Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage Ft. Slope of lot .%Structure setback to right-of-way iO .Ft. (10’minimum) (Sewage System Permit required before installation).Structure setback to septic tank T. (20'minimum) (Sewage System Permit required before installation).Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System IQ 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 buiiding footings have been constructed. * This permit is only valid after verification from the O.T.L.SD. that a conforming sewage system wiil be instalted to service this tot... Contact Roilie Mann at 864-5533. Q 31Dated: Signature of Owner ) Dated: Land & Resource Management Office I0^a / /PERMIT FEE $RECEIPT NO. Comments:4 I 1 13i Form No. BK — 0597-002 267.685 • Victor Lundeen Co . Printers • Fergus Palls. MN * 1-800-346-4870 INSPECTION RESULTS Make all measurements and computations Structure Set Back from Ordinary High Water Level Ft.Ft.JOO Structure set Back from Top of Bluff Ft. Ft. 5oo"*Ft.Structure Set Back from Road Right of Way Ft. Ft. & Ft./o Ft.&Ft.Structure set Back from Lot Lines Ft.Ft.Structure Height Ft.Structure Set Back from Septic Tank Ft. Structure Set Back from Absorption System Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level____________________ f Ft.Ft. % %Land Slope at Building Line Inspector’s Comments / Sketch:, fctr'-. ]00 /Wrs - Inspector's Signature Date 0/ Inspection Time of Inspection yyy/) -:7" H/7?o ^ o^<7X/W^>r/ •f I- /3Z7.3/ ■■/3^^. 5/--■ --2.<i,6<^. 7J5--- V)\ V X 'n /X: 'oi V-,( . ' OIIX. 0 ' ^\\/ 'i ^< ;j /1 \1/ !\s\ \\ (/ \(I '• ^]/ <fx/c7Z//zA<^(/ j /X /pa/ y/?/(fza^z<^ s W .Tlidt part of Goverrjuent Lots 1, 2 and Otter Taii. Count west comer ;f O'7erru,.er.t L.t L ^Mi: rxescta, deceriL.i •(w r f sa- ing of East o;-. tne r.oitnerly iir.e rf ; tance of 1329.31 feet tr, noint 7b- . K ^ i>.'O f i -eu: •1 re,ir:i.:.„ rf Ea.st on tht 1, 2 -uid 3 for a distance o,f l32'‘,3’ :;;c!e ci less tc the shore,:./ f Lorn a;;d westerly on said st!<,.ieline tc th.e a beaiing of Sc atii 0° 02' contin.uii'.g cr.N t i/i oo" E'.ot L ro teet ..r;re c: less tc Jufject to the ri road over the .ipprc xicate lurt^.erly 33 /< •02' 25" West l55t5°icres raore or less.1 (/O'/(7///y/O'/ /J^ /pa/ //? /cy/?</</c/ /d /cp/p/'d'^d'/y / /Pt>/ cj>ov /a/ ///?<y D " <c; ■ — /p/d/di<7 ^ (///p '^>/'r(///7 CERTIFICAl ROBERT B. OSLUNl OMK ENG <3/'\\ \\ \REGISTERED LAND SURVEYORS CONSULTINC N V-f-r OS /, \• X E OTTER TAIL COUNTY Grade & Fill Permits uq?r I OWNER’S NAME: l4^rr\Ti~nuJ T)Q.. ^ ^ m iJ ^s^l/ LiOCSltlOnS Lake No.^S^Sec.3j._Twp. Range 31 Twp. Name ^2.6 -THg. Address ■| U-(- .\ V\ 19 , Expires 19?rIssued-^ Work Authorized Z3> r Q s CJlVn T Q ^ ftjvwo-vkJ^ .S V~<jl d ov.y»<L^v .Q W C CK •yx W AvtA CXwj^ ^’\.\V ^O-'—V’Vi'fA.^^yv \ysl O O S Cl V\ r Q U. I 1,r5o'>c5'o Oy COy .JD:n«-7( ^‘yV-V.. 0 __ _____ NOTE: This card shall be place?in a conspicous place not more than 4 feet above grade on the premises on which work is to be done, and shall be maintained there until completion of such work. NOTIFY DEPARTMENT OF LAND AND RESOURCE MANAGEMENT, TELEPHONE (218) 739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED. Kvj 0 work, V)\AAr^\w 5^0 OTTER TAIL COUNTY, MINNESOTA Board of County Commissioners Land and Resource l\^apagemeot Official I u-&1. Earthmovihg shall be done between 2. Entire area shali be stabiiized within 10 days of the compietion of any earthmoving. 1 3. Owner is iegaliy responsibie for aii surface water drainage that may occur. d Nn fill «hall antpr nr ha takan from tha haria nf a niihlic watar without a valid nermit from the Stata of Land & Resource Management OfficeTo: We would like to get a permit to improve our property which is next to Long Lake. Please look at the rough layout and the listed changes and let us know if we would be able to do them. -Road -smooth out holes and bumps -take out stumps and rocks that are in the way -level out campsite 'Jamlob' K loo* ><^ >o -Duck Pond -located in partially low area -it holds water slightly in wet years -20-30 yds wide and 60-80 yds long -would like water to be l-3ft deep -leave a couple little islands with tree and brush -would have brush along south edge and more open on north edge -dirt would we pushed out to the sides-i^^-^t oot W We have done a lot to this land to improve wildlife habitat and the pond would be another step in making for better habitat. Sincerely, Mike Vierzba 816 Hamilton Drive Duluth, Mn. 55811 F > £ L 0 'h'" ',C Hoc fS - L A K Ji. *-T.135N. - R.39W..RUSH LAKE5< -ii a 1 PEflHAM PQ. 70 >■.®:ta> ®1 oT ■ '•* ' ' ~ I ^ j farms ® In, /axrfvv 1l/i5 I i. ^TTFnr’jyv *uifOb I' I ^ ^ I22 I ^108 Kicwitty ^fcriiLMUk, (^HIQDorri ifUlV)M.8I■i i5lynil3 •Vi6t®>-'w,»\11Kil0L| 0 <P Ort/iuT fltfbin Ito. , I___ t^Mori/I 1tmu6 ffuui i4 ^ ItOd'HARlOni '•terlO ' i-1\lakcn ^ f tIlytttLIriTfTUfaJ)cilL'IW)3J} 1*^ I 1/1 g -sa_l!LIDilitlaf (D| ^ \VP V)DonItpO 4Dtti'!Orte- ■"|j)jgmtr • Dondkt jI La%tij I 1 *^0 f J)bM]/t/ aeVvmti-v 4o ‘^D\/■iottphj* Hruatts ('tkrvuxuM. flurbu’i* hlkhtrm Lion* UkontZk •iuw I’Jtl Wifothurt Wii(f r^rtnWh/ loKivfktr <*- fcLidbtth/ n ,® IcD&Lt Kliih/ I ^Lbtfkxft^0*i58<W iW)I55® i uJoUtr . ra ^QSfZi> ’ dfthaP OditfL CaUiut/M56 24d\KiiiA:Hicyiiitid. Df^roihi^ A/4/i/ns fctmircLJrlUjcpzrT)ltO£iL fliriflj 1IfuU,,^.I5lion* amnu^ —TV lIML■i JJoliJjinr-a Doiltr ii6 i152,6aiKitLKt1<A^»^\t^-W I *4 ilartnct u.. \. 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