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Home My WebLink AboutXanadu Island_25000290185000_Shoreland Permits_♦ Grade & Fill Permit #nq o44o7 PROPERTY OWNER 5o(j,SEC. TWP. NAME £ »/er+5LAKE NO. LEGAL DESCRIPTION: SuiaL.-v\ vVCr cv\.^cyp J ikWORK AUTHORIZED et.pp/OC cU^\k o-f 1Q*\ J-.^V ~C\ 11 ir\ 1—ICa 4^ A^-W e.'f \ ^AW\.*.')C Ovv Us/v^K 0-^1/So y Ji .yT^^rtS 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. 1. EAFITHMOVING SHALL BE DONE BETWEEN 2. Entire area shall be stabilized within 10 days of completion of any earthmoving. 3. Owner is legally responsible for all surface water drainage that may occur. 4. No fill shall enter or be taken from the beds of public waterwithout a valid permit from the MN Department of Natural Resources.. 5. If the terms of this permit are violated, the entire permit may be revoked and the owner may be subject to l^al prosecution. ieasures4Tiust be implemented prior to any topographical alterations.6. Erosi APPLICATION FOR GRADE & FILL PERMIT*- LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us miPermit No.PLEASE PRINT OR TYPE ALL INFORMATION LAKE/RIVER #LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP. NO.RANGE TWP NAME ?\0(a BlV>Mt:I5S> PARCEL NUMBER(S)PROPERTY (E-911) ADDRESS 35’48‘V _________________________________________________________________________________________■AU G-oo-^. Lo'X 5 Toop 155 RavA^ 40 OHev'Tovt'l ColxvaA'-n__________ ^ See y4f~fadUa/^^ ^!^~coo >Bsr-ooo LEGAL DESCRIPTION Last Name First Initial Mailing Address DAYTIME Phone No. gfcM 8o=?6Wow^Ki B>v‘*^cx.w L.OnA.SK» OLVAjOT 5Property Owner g WV4-. aAn^ S~(b S’l£> 7li:XS'd <^o. /-/oo^ 83- Lq/Ol AaKJ 3"oVvv CWt£.W-Vi5ev\Contractor Name Lie. # NOTES: 1. The lotlines and project area(s) must be staked. 2. If project disturbs more than 1 acre of land you are required to obtain a General 5-?/-t/6Received DATE PROJECT REQUEST (You may use the grid on back for required scale drawing): DESCRIBE YOUR PROJECT(S): To >Nj-^\ ~Cl \\ OwagV Q cIy'i\jAV>»c\^ 6>-f() i vIcUa^^. 4q ^ * VA iXYO.|?prOiC • \j^V^ j. uo q DETAILED INFORMATION: AREA TO BE CUT/EXCAVATED:Ft.Ft. Ft. Maximum DepthLengthWidth » 4 S' Ft.^60 Ft.AREA TO BE FILLED/LEVELED:Ft. Maximum DepthLengthWidth SLOPE OF BACKFILL AT FOUNDATION:Ft.Ft. Distance Extended From FoundationMaximum Depth CULVERT:If Yes, must indicate size and location on drawing. Yes No (3'VYDk'U-R iTYPE OF SOILS AND/OR FILL MATERIAL: c\ab>S> /S-OTOTAL CUBIC YAFIDS OF EARTHMOVING REQUESTED:cu- A ^ ~ /0-"O (p fiGNATURt OF PROPERTY OWNER/AGENT FOR OWNER RECEIPT NUMBERDATE BKOfOe jl^-parcel-Number(s) of tt|ie existihg|^i^ piroposed Ibtlinesl road ..Must'also.inclucfa^all.prbpose'd-topdgraphjDrawing must be to scaleTjDrawing shall identify pr;oiect and include the setbacks to a|f ordinar.y.highIwate4ievel(s),lstruc^re(sj>^eptice.tank(s)i.drainfi^(s),.bluff(S).&.wetland(s) T Scale I mperyious^SiLi rface”T :: u uTTTlFtI ■?:tI I*W D: w FA B> s 4losi\m \_vpc\v:s&E 6X.0^ J V aI 1^a -I—+ Signature of Property Owner -1-af-i-bate- -Lunde6n{C<BK-^ 05 .322 369-•-V etc js Ijaiis,.WN_»_l-800-346-4870-li.Prjniers • Ferg ! APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE - Office GOLDENROD - Inspector YELLOW - Owner PINK - Assessor /SWPermit No.LEGAL DESCRIPTION 3 BLUFF ZONEAND □ YES ^ NO LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER /33 ¥o SECTION TWP NO.RANGE TWP NAME ^(p ^^>OLd PARCEL NUMBER (S)GRADING / FILLING a YES # OF CUBIC YARDS □ NO FIRE NUMBER ^5- a/SS-tXO IDENTIFICATION: Please Print All Information Last Name__________________Fjsl_______Initial ^ V/uM^ Mailing Address — No. Street, City, State, and Zip Code (Daytime) Property Owner NameContractor State Lie. # 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 New Structure(s) ( ) Addition(s) { )MH/RV______________ PROPOSED USE ( ) Dwelling ^i^^Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS) (p^lndividual Permit # / ( ) Collector Permit #, ( jOTLSD*YEAR CHARACTERISTICS OF NON-DWELLING ( ) Utility Structure CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING ^ Detached Garage ( ) Screen Porch( ) Boathouse( ) Basement ( ) Walkout ( ) Attached Garage ( ) Dwelling ( ) Replacement Dwelling ( ) Addition to Dwelling ( ) Existing Dwelling shall be removed on or before. ( ) Gazebo ( ) Utility Structure( ) Other Outside Dimension FI. X d'(o Ft ID Ft. & ( ) Other. Outside Dimension Outside Dimension.IC> Ft.Ft..Ft. X Lotline Setbacks Ft..Ft. X Lotline Setbacks .Ft.&.Ft.OHWL Setback Ft.Lotline Setbacks .Ft.& OHWL Setback .Ft.(><) NoBathroom: ( ) Yes (If Yes / a complying Sewage System Required).Ft.OHWL SetbackTotal Bedrooms tS LMaximum Height / 35 Ft. (2 story)Maximum Height / 10 ft. (1 story)Maximum Height Ft..story 4-3'? OMJidJ .Sq. Ft. Impervious Surface Ratio .%Sq. Ft. Impervious SurfaceLot Area 3 Ft. (3’ minimum)Ft. Elevation of lowest floor above OHWLWater Frontage AO .%Ft. Slope of lotStructure setback to right-of-way /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). Structure setback to septic tank_____________ Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System /a 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 responsibility to inform the Land & Resource Management offi^ * This permit is oniy vaiid after verification from the O.T.L.SD. that a conforming sewage system will ^ the building footings have been constructed. <d to sea/ice this lot... Contact Rollie Mann at 864-5533. O/her POn Dated: Signature of Dated: Land & Resource Management Office ^ ^ don .no RECEIPT NO.PERMIT FEE $ Dody nupvhjyjrijjLd^ A(u m dAy’ ad: if /ajL -AttJt Z-G v/( kx_ V .3^ C4"o Q VI /'ootc Comments: -'"CXj -Form No. BK — 0597-002 ^290.621 • Victor Londein Co . Printers • Fergus Falls. MN • 1-800-3A6-4870 9 -2_-=( r WHITE - Offiot* GOLDENF^D - Inspector YELLOW ■ Owner PINK - Assessor APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 • FERGUS FALLS, MN 56537 Permit No.LEGAL DESCRIPTION LA JyJj!) /J BLUFF ZONEAND□ YES [2; NO.'UT cU-L^''LOCATION SECTION TWP NO.RANGELAKE/RIVER CLASS TWP NAMELAKE NUMBER LAKE/RIVER NAME n GRADING / FILLING FIRE NUMBERPARCEL NUMBER (S) a iSoYES# OF CUBIC YARDS /- tV:□ NO ' fe,<Ar«-v .IDENTIFICATION: Please Print All Information TELEPHONE NO. (Daytime)Mailing Address — No. Street, City, State, and Zip CodeFirst InitialLast Name / y:J ! t ✓)Property Owner ui±L=SLfl(r>41\ / 7ZZy. ..yj(/h: i:/ V. gName rContractor State Lie. # '5ONSITE 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 ( ) New Structure(s) ( ) Addltlon(s) ( )MH/RV______________ PROPOSED USE ( ) Dwelling p^Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS) (^ Individual Permit # / / --A ^ f ( ) Collector Permit # ( )OTLSD*YEAR CHARACTERISTICS OF WOASCHARACTERISTICS OF NON-DWELLING Detached Garage CHARACTERISTICS OF DWELLING ( ) Screen Porch( ) Boathouse( ) Utility Structure( ) Dwelling ( ) Replacement Dwelling ( ) Addition to Dwelling ( ) Existing Dwelling shall be removed on or before. Outside Dimension. ( ) Basement ( ) Walkout ( ) Attached Garage ( ) Utility Structure( ) Gazebo '9( ) Other Outside Dimension ^ (yp Ft.Ft. X ( )Other. Outside DimensionFt.10.Ft..Ft. X Lotline Setbacks .Ft.&.R..Ft. X .Ft.Lotline Setbacks ,Ft.&OHWL Setback .Ft..Ft.&Lotline Setbacks .Ft.OHWL Setback Bathroom: ( ) Yes (y) No (If Yes / a complying Sewage System Required).Ft.OHWL SetbackTotal Bedrooms__________________ Maximum Height / 35 Ft. (2 story) I/ ;Maximum Height / 10 ft. (1 story)Ft.Maximum Height story ^■3 7 d.c^cM^.%.Sq. Ft. Impervious Surface Ratio.Sq. Ft. Impervious SurfaceLot Area .Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage Structure setback to right-of-way !.%.Ft. Slope of lot //■;) .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). Structure setback to septic tank_____________ Dwelling setback to Soil Absorption System___ 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 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 conforping sewage system will be installed to service this lot... Contact Rollie Mann at 864-5533. ^Sigrvture of Dated: Dated: Land & Restxjrce Management Office . .RECEIPT NO. /So ■ onPERMIT FEE $ At ii-/U-y/A '/J/Uf.fuComments: :iJtJ U fy- , -'f / :■i A y A-I ^ Lwndppn Co . Pf.nler^^ Fprgus Pant MN . 1-800-346.4870 2-0 Form No. BK — 0S97-002 'i.. 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. I <Structure Set Back from Road Right of Way Ft.Ft./ODQ Ft.&Structure set Back from Lot Lines ,Ft.&.Ft. Structure Height Ft. Ft. 4Structure Set Back from Septic Tank Ft.Ft.fOc/ 4Structure Set Back from Absorption System Ft.Ft.loo 4Elevation Of Lowest Floor Above Ordinary High Water Level____________________Ft. Ft. Land Slope at Building Line % % IInspector’s Comments / Sketch: 6> V <4 Q Os., /-C=, Inspector’s Signature 9- xAt Date of Inspection Time of Inspection /(I ^ bO 4%0yf^X OaJ^oxIMjU aJz '(>■^i- ''y 'iy'ry < ■/■ .\0 ‘i'r*rO 'irk'. V\kuiL' ✓<k\ ■o vO /\T)■<c>Vn ,'Z' ix k' k' kX>o■i»\0 k' -t ,- ■i.nvD LSJno oC) lO 5NK 1'.