HomeMy WebLinkAbout24-0032i y
RECEIVED
ijo 2 5 2023
Bayfield Co.
Planning a,,d Zvnlnp Fluency
ReC'd for Issuance
cp 6 2023
BAYFIELD COU Zoning District
SANITARY PERMIT APP I"Witarial Staff lekas.class
I. -APPLICATION INFORMATION
Soil Test
County /y5�
(Please Print AN Information)
No:
Permit No: —a
a
Property Owners Name:
County: 82yfleld
S+t Q e d- (Cvoke0 01�
Address of Property:
Property Location:
- .a 99 S�S1CrW� If2. [
Y. V..,S T 50 N, R 06 E (or)®
Property Owner's Mauling Address:
Township:
Gov. Lot #:
aO CG. RQc, Loop
i1
City, State Zip Code
Phone Number
Lot #
Block #:
CSM #:
CSM Doc #
Subdivision Name
Q 8791-5
50S-60 a
a.
I S-' cl
ll. TYPE OF BUILDING: (Check One) 4600
❑ State Owned
Tax ID#:
❑ Public (Explain the use/purpose
p
1 or 2 Family Dwelling -No. of Bedrooms
II. TYPE OF PERMIT: Check only one box on line A. Check box on line B if applicable)
A) New, ❑ Replacement ❑ County Private Interceptor
���❑(((
IV Reconnection ❑ Repair ❑ Revision — ❑ Transfer of Owner (List Previous Owner below)
�❑
B) A Sanitary Permit was previously issued. Previous Permit Number: aa-IlAate Issued: I $ j2,
IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) • Replacements need previous permit number and data filled out above
C) ❑ Pit Privy ❑ Vault Privy (Vault size: _gallons or _cubic yards)
❑ Portable Privy ❑ Camping Transfer Unit Container ❑ Composting Toilets ❑ Incinerating Toilet
V. ABSORPTION
SYSTEM INFORMATION:
t. Gallons
2. Absorp. Area
3. Absorp. Area
4. Loading Rate
5. Perc. Rate
6. System
7. Final Grade
Per Day
Required (Sq.Ft.)
Proposed (Sq. Ft.)
(Gals. i Day / Sq.Ft.)
(Min. Inch)
Elev.(Feet)
Elev. (Feet)
VI. TANK INFORMATION:
In Gallons
Total
Gallons
# of
Tanks
Manufacturer's
Name
Prefab.
Concrete
Site
Constructed
Steel
Fiber
glow
Plastic
Leper.
APp
New
Existing
Tanks
Tanks
Septic Tank or
Faso
1a�
,
t\re&0r
�J
Tank
Lift Pump Tank /
Lift
SO
i
W`teso �—
Siphon Chamber
VII. RESPONSIBILITY STATEMENT:
I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans -
Owner's N2Te(s): (Print) ifappong forseccar C above
natu s): (No Stamps)iA
Plumbe1rs Name: (Print) Irapp/y/ng for fw A o B) above
Plumb J n re' (Np Stamp
MP/MPRSW No:
1a88-63
Plumber's Address: (Street City State, Zip Code)
Home Phone:
Business Phone:
149 C�bj
-116-3 3-d566
-t►s-aOg-�Sa
Vlll. COUNTY / DEPA9TMEWT USE ONLY
❑ Disapproved
Sanitary Fee-
Date Issued:
Issuing Agent's Signature / Date:
Approved
❑ Owner Given Initial
PePPejMiit/Transfer
�} '" *7
r�/ I /�
Of G(lvf.
Adverse Determination
�,J�/ 1
_
DL CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL
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00IX �Co►,r.ec�4�rA b� t�/ws ���ww.k�er.
rio[ Pion on reverse side
if Z
Page 2 of 4
STEPHEN & CAROLE BRODERSON
LOT 2, NE 1/4 of NE 114 S22 T50 N-R 06 W
Town of BELL
County of BAYFIELD
PID: 04-010-2-50-06-22-101-000-23000
TAX ID: 34959
Q= Benchmark: NAIL IN 12" BASSWOOD
8" ABOVE GROUND = 100
SHED
G
Y
Scele: 1" = 4V (units marked)
�b
'CURRENTLY NO WELL ON SITE
MAINTAIN SETBACKS:
-25' MINIMUM FROM WELL HOLDING TANK
-SO- MINIMUM FROM WELL TO DRAINFEELD/MOUND AREA
Sewa� Con�ec�iw�'�Os�.¢�
i
n�
AREA
B _
ESER Po1
RECEIVED
vitj 25 2023
Bayfieid Co.
Planning and Zoning AgenaY
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Bayfield County, WI
+— Wetlands • Building bayfeld_gis.SDE.TBayflekl bayneld_gis.SDE.GuI IYand bayfeld_gla.SDE.T Tdpp bWWdylaSDE.T Pal M g baynsldyls.SDE.T_Nanwkagon 0 OW 0.04 0.08 ml
Riven baynelclAmMET Cable — Index — Ind. — Index — Intlex Index
0 0.03 0.07 0.13 km
.._. ppprsximale Parcel Boundary — IMex — InlvrneOlak InlermetlWe — InbrmeNele INermetllek Inlermedele
Road! Type_
InlennedlNe baideldyls.SDE.TBanadab bayfieMAIs.SDE.TWasbbum bayWd_gIs.SM.ftsploeny_Islancl bayfWdjle.SDE.T Dulu WygeWyle.SDE.T Lincoln
County bayfleld_gis.SDE.T SayNew — Index — Index — Index — Index — Index Baybeld. Sayneld County L Ramrda Dapadmenl
Towm — IMex — Inlen edixle — Inlermediae — Inlermetllale — InUunwidleU — InletmaQale
Intennedlale
Building Fmlprm12015
Baynekl County Zoning Awl"don
bllpsy/m ,x;.bayaeaavunly.WI.gw2 INWRBI
Town, City, Village, State or Federal
Permits May Also Be Required
LAND USE - X
SANITARY - X (22-170S)
SIGN -
SPECIAL -
CONDITIONAL -
BOA -
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
No. 24-0032 Tax ID: 34959 Issued To: BRODERSON FAMILY TRUST/STEPHEN &
CAROLE BRODERSON TRUSTEES
Location: '/4 of '/4 Section 22 Township 50 N. Range 6 W. Town of BELL
Gov't Lot Lot 2 Block Subdivision CSM# 1549
IN V.9 P.179 IN DEED DOC 2022R-596299
For: RECONNECTION - Connection of Storage Shed to Sanitary Permit # 22-170S
(Disclaimer): Any future expansions or development would require additional permitting.
Condition(s): Building not to be used for human habitation. Personal storage and bathroom only.
To be connected by Master Plumber.
You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or
modification of construction that violates the law or other penalties or costs. For more information, visit the department of natural resources wetlands identification web page or contact a department of natural resources service center (215) 685-2900.
NOTE: This permit expires two years from date of issuance if the authorized construction
work or land use has not begun.
Changes in plans or specifications shall not be made without obtaining approval.
This permit may be void or revoked if any of the application information is found
to have been misrepresented, erroneous, or incomplete.
This permit may be void or revoked if any performance conditions are not
completed or if any prohibitory conditions are violated.
or if any prohibitory conditions are violated.
Alessandro Hall, AZA
Authorized Issuing Official
February 7, 2024
Date