HomeMy WebLinkAbout25-0295BAYFIELD COUNTY Zoning District ^2
SANITARY PERMIT APPLICATION(IEC 23 ?024 Lakes Class
I. APPLICATION INFORMATION
Soil Test I County
(Please Print All Information)
No: I Permit
No: LB - 02
Property Owner's Name:
County: Bayffeld
Pc -Mir S
Address of Property:
Property Location:
7
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'% Y.,S//-7 T 7 N,R Q E(o W
Property Owner's Mailing Address:
Township:
Gov. Lot #:
/073 a Cr
arne
Ci y Stat Code Phone Number
of #
Block #:
CSM #:
CSM Doc #
Subdivision Name
LJ4fMOt ml)cjYf9c.2- 3
II. TYPE OF BUILDING:• (Check One)
/�
❑ State Owned
Tax ID#:
❑ Public (Explain the use/purpose )
1 or 2 Family Dwelling - No. of Bedrooms
Ill. TYPEOF PERMIT: (Check only one -box online k oz on line:B, if a p licable
A) ❑ New ❑ Replacemen unty Private Interceptor 4frc //w4&A �z Z
*econnection ❑ Repair ❑ Revision '* ❑ Transfer of Owner (List Previous Owner befo
B) A Sanitary Permit was previously issued. Previous Permit Number. 22($?t1 I Date Issued: 7/1'? tgg
IV. TYPE OF NON -PLUMBING SYSTEM:.(Check-One) * Replacements need previous permit number and date 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:
1. Gallons
I 2. Absorp. Area
I 3. Absorp. Area I
4. Loading Rate
5. Perc. Rate
I 6. System I
7. Final Grade
Per Day
Required (Sq.Ft.)
Proposed (Sq. Ft.)
(Gals. / Day / Sq.Ft.)
(Min. Inch)
Elev.(Feet)
Elev. (Feet)
VI. TANK
Capacity
Fiber
INFORMATION:
In Gallons
Total
Gallons
#of
Tanks
Manufacturer's
Name
Prefab.
Concrete
Site
Constructed
Steel
-
glass
plastic
Exper.
App
New
Existing
Tanks
Tanks
Septic Tank or
Holding Tank
Lift Pump Tank /
Siphon Chamber
VII. RESPONSIBILITY STATEMENT:
I the undersigned, assume responsibility for installation of the onsite sewage system shown<i 9te attached plans.
Owner'sNam(s): (Print) a pprve Section Cc ve
er'sSign oStamps)
!
lumber'sName: (Print) (feppryingfor Section AwBjabove Plum $Sign No Stamps)
MP/M RS �Q., /
—
C777um
aYs ddress4Stieet, llty state, Zip Code) I
Home Phone:
Business Phone:
I. COUNTY! DEPARTMENT USE ONLY
❑ Disapproved
Sanitary Permit/Transfer Fee: I
Date Issued:
I Issuing Agent's SI lure / Date:
Approved
❑ Owner Given Initial
Adverse Determination
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)
Cjl �,125
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IX. CONDITIONS OF APPROVAL! REASONS FOR DISAPPROVAL: - - -
Plot Plan on reverse side
I3'-YFIELD Bayfield County
Planning & Zoning Department
117E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-4010
Property Owner:
Description
Private Sewage System Reconnection
Submission Number:
CS -00096
Transaction Number:
CS-00096-2BC60
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 3728
Paid by: GREG'S PLUMBING, LLC, 13600 COUNTY HWY H, IRON RIVER, WI
54847
Payment Type: Check
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
Town, City, Village, State or Federal
Permits May Also Be Required
LAND USE -
SANITARY — Private Interceptor to #220991
SIGN -
SPECIAL -
CONDITIONAL -
BOA -
BAYFIELD COUNTY
1 I :UA14I
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
No.
25-0295
Tax ID#
2042
Issued To:
CONKLIN, PETER C & SUSAN H
Location:
Section 17
Township 44
N.
Range
9 W. Town of Barnes
Gov't Lot I Lot 4 CSM# 000715
Residential / Commercial Structure in an Ag-1 Zoning District
For: County Private Interceptor
(Disclaimer): Any future expansions or development would require additional permitting.
Condition(s): To meet all setbacks. To be constructed per plan. Adhere to privy agreement.
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 (715) 685-2900.
NOTE: This permit expires two years from date of issuance if the authorized construction Tracy Pooler, AZA
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.
Authorized Issuing Official
May 22, 2025
Date