Shoreland Alteration Permit Application

SHORELAND ALTERATION PERMIT APPLICATION

Kandiyohi County Zoning

County Office Building, 400 SW Benson Ave, Willmar, MN 56201, 320-231-6229

Version: November 2006

OFFICE USE Fee $100.00_ Date Received ______Date Mailed ______Permit Number ______

Zone _____ Building Code ______AS 400 ___ Excel ___

Name of Applicant______Daytime Phone______

Mailing Address______City______State______Zip______

Property Address(911)______

Tax Parcel Number ______Township ______Section _____ Lake______

Legal Description ______

______

Request:______

______

Contractor Name ______

Any Wetland Alterations: Yes No Located in Floodplain: Yes No

Project Type Type of Erosion Control Proposed Project Scope

□ Vegetation removal □ Sod Closest distance to ordinary

□ Fill Only □ Mulch Only High Water Mark: ______

□ Grading Only □ Straw bale checks Area of disturbed ground

□ Rip Rap □ Fiber Blanket (length x width)______

□ Retaining Wall □ Seed Only Volume of fill in cubic yards

□ Sand Beach Area □ Geotextile (length x width x depth) ______

□ Stairway in impact zone □ Seed & Mulch Average Slope of

□ Deck in impact zone □ Other (specify)______Work area: ______

Feet of rise for each ten (10) feet of

Horizontal distance

This application is not complete until plans are submitted which adequately describe the proposed project.

I hereby certify that I have examined this application and acknowledge the information submitted to be true. I further agree there shall be no changes in plans or specifications to the work authorized herein unless such change is first approved in writing by the zoning administrator.

The construction site shall be kept reasonably free of debris at all times so as to not create a public nuisance.

The granting of this permit does not exempt the permitee from having to secure other permits from other state, federal or local units of government, which may have jurisdiction over portions of the authorized project.

NOTICE: Any violation of the conditions established in conjunction with the Shoreland Alteration Permit granted pursuant to this application may be prosecuted as a misdemeanor as more fully provided in CHAPTER 2, 2-8 and 2-9 of the Kandiyohi County Zoning Ordinance.

Signature of Applicant ______Date ______20 ____

A Shoreland alteration permit is hereby approved to begin construction and is issued for one (1) year from date of permit for the above location under existing regulations and is approved for zoning compliance.

Conditions______

______

Zoning Administrator ______Date ______20 ___

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SITE PLAN

NAME ______TAX PARCEL NUMBER ______

Information to be included in site plan

______Location & size of proposed project ______Area of disturbed ground

______Closest distance to ordinary high water mark ______Volume of fill in cubic yards

______Average slope of work area

SITE PLAN

NORTH é

Version: November 2006

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