HomeMy WebLinkAbout23-0343APPLICATION FOR ii , ! -SCSS:?JJL t.'J .:.-...iRECREATIONAL VEHICLE
Bayfield County Planning and Zoning Department
P.O. Box 58
117 East Fifth Street
Washbum.WI 54891
Phone-(715) 373-6138
Rec'a ror issuance
Office Use:
Zoning District/Lakes Class <L\- \
Application No.
Date.
Fee Paid 1in<r°0.^3:^AU3 03 2023 (I—a^^-
INSTRUCTIONS: No permits will be issued until all fees are pai<f.
Checks are made payable to: Bayfietd County Zoning Department. Secrefan"fl| StaffDO NOT START CONSTRUCTION UNTIL ALL PERMITS HAVE BEEN-R
Changes, in plans must be approved by the Zoning Department
Property Owner ^AL^ ^ ^^.LSTCO^ Property Address \\^ -T£4(\^^ t^^.
of RV placementMailing Address ^ C^'~l (\ 1-n\ ^T """ t"nw"re"1" f-^A/J^ \^ I t£U^ \J^H
CM ^(^(LUC^Q . (AS I S'4 ^ 2. ^ Agent: .
Telephone ^^ Y^' (2^ 1 _ Written Authorization Attached: Yes () No ( )
Accurate Legal Description Involved in this request:
J/4 of_1/4 of Section .2 "/Township IL^Lf N. Range ^ (oW. Town of_
Gov't Lot^_ Lot | ^_ Block_ Subdivision _ CSM # ^<? ^ C?
Volume_ Page_ of Deeds Parcel I.D. # iA-7 ^ ' ^ \ _ Acreage ^ • I _^
Additional Legal Description: _ ATTACHCopy of Tax Statement
Is your RV in a Shoreland Zone? Yes ^ No If Yes, Distance from Shoreline: 75' or greater"*^ < 75' to 40' less than 40'
RVi NewpC Replacement D Year: 7-0\c\ Vin#:_^^
Make of RV: ^-\^\ 0^ _ Model of RV: <fb?^ R^£^
FAILURE TO OBTAIN A PERMIT or PLACING RV ON PROPERTY WITHOUT A PERMIT WILL RESULT IN PENALTIES
APPLICANT- PLEASE COMPLETE REVERSE SIDE
For Office Use Only Zoning District/Lakes Class:
Permit Issued: ^f^QilJifSamtary Number Q?3'-£)3</3 Date //>• ^-nte^3
Issuance Date /<D-^/ ~^CQ3peffn\i Number ca?3 ~^)5^t3 Permit Denied (Date),
Reason for Denial:
Inspection Record:.
Variance (B.O.A.)#.
a
By_7/^1^37r Date of Inspection ^r " •
Condition: RV may be placed up to 4 months from-iissjuanofe date^^fl/lust be removed by: ,~^rZ^""""""""""^7J^
Signed.
Inspector Date/of approval
February 2013
IMPORTANT
Detailed Plot Plan is Neccessarv
1. Name and use frontage road as a guideline, and indicate North (N) on plot plan
2. Show the RV (Recreation Vehicle) location
3. Show dimensions in feet on the following:
a. RV from centertine of road(s). d. RV from lake, river, stream or pond
b. RV from right-of-way line e. RV from Privy
c. RV from property lines
Lot Line
Lot->
Line
^'^^"vV6^
Q —&0^?c)W po\^
CfrAW- ^i- /^
ii3 ^
4^
w^"u^
<(^
[^
•(-Lot
Line
Name Frontage Road F\^ Ptl^^-L^^}
NOTICE: The local town, village, city, state or federal agencies may also require permits.
I (we) declare that this application (including any accompanying information) has been examined by me (us) and to the best of my (our) knowledge and belief it is
true, correct and complete. I (we) acknowledge that I (we) am (are) responsible for the detail and accuracy of all Information I (we) am (are) providing and that it
will be relied upon by Bayfield County in determining whether to issuf a permit I (we) further accept liability which may be a result of Bayfietd County relying onthis information I (we) am (are) providing in o^it( ttfls applio^tipn. |(we) consent to county officials charged with administering county ordinances to haveaccess to the above described property at ai<y ^e((soflab|p tim^ f^r tHBjyu-pose of inspection.
Owner or Authorized Agent._Date_7
Address to send permit ?(^<\6^ €. ^oLU e iWL^T^^
/2S-/2o23
February 2013
2^7,^ 7r\^ ^T-C^^o-^
BAYFIELD COUNTY
SANITARY PERMIT APPLICATIQ^
Zoning District ^-/
Lakes Class __1
I. APPLICATION INFORMATION
(Please Print All Information)
Soil Test
No:
County
Permit No:
1^-Q.Lj^ l-lei.^r^tJ County:Bayfield
Address of Property: ^ ^ ^iCAD^^l
_^^X\ftU(^L& <OP-\^ "^~i
Location:
1/4 1/4,S ^>7 T (^</ N,R 0{fj E (or)l
Property Owner's Mailing Address:
^ -TTU <sr
Township:
(<3^A-t^OV»^:^
Gov:Lot#:
City^tate ^ . I Zip Code | Phone Number"UA^fcJ^D ,^\\ ~S^2^ I > iS--^:^
II. TYPE OF BUILDING: (Check One)^Lot #
1
Block #:CSM#:
2^0
CSM Doc #Subdivision Name
D State Owned
^Public (Explain the use/purpose
1 or 2 Family Dwelling - No. of Bedrooms
Tax ID#:
J
III. TyPE OJF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) J.3 New II Replacement II County Private Interceptor
Reconnection |_| Repair |_| Revision ** |_| Transfer of Owner (List Previous Owner below)
B) I_| A Sanitary Permit was previously issued. Previous Permit Number._Date Issued:
IV. TYPE OF NON-PLUMBING SYSTEM: (Check One) * Replacements need previous permit number and date fitted out above
C)Pit Privy D Vault Privy (Vault size:jallons or cubic yards)
Portable Privy |_| Camping Transfer Unit Container |_| Composting Toilets |_| Incinerating Toilet
V. ABSORPTION SYSTEM INFORMATION:
1. Gallons
Per Day
2. Absorp.Area
Required (Sq.Ft.)
3. Absorp.Area
Proposed (Sq. Ft.)
4. Loading Rate
(Gals./Day/Sq.Ft.)
5. Perc. Rate
(Min. Inch)
6. System
Elev.(Feet)
7. Final Grade
Elev. (Feet)
VI. TANK
INFORMATION:
Capacity
In Gallons
New
Tanks
Existing
Tanks
Total
Gallons
# of
Tanks
Manufacturer's
Name
Prefab.
Concrete
Site
Constructed Steel
Fiber
glass
Plastic Exper.
App.
Septic Tank or
Holding Tank ^.Z<wrtc ><.
Lift Pump Tank /
Siphon Chamber
VII. RESPONSIBILITY STATEMENT:
I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Owner's Name(s): (Print) If applying for Section C above
R,O<L?PS(J^'-^ feusTiSf^
Plumber's Name: (Print) If applying for Section A or B) above } Plumber's Signature: (NoStai
Owner's Siw imps)
MP/MPRSWNo:
Plumber's Address: (Street, City State, Zip Code)Home Phone:Business Phone:
VIII. COUNTV/DEPARTMENT USE ONLY
Approved
Disapproved
Owner Given Initial
Adverse Determination
Sanitary Permit/Transfer Fee:
00
Date Issued:!S^ 110-4-^^2^Issuing Agent's Signature / Date:
/^??^/<
K. CONDmONS OF APPROVAL / REASONS FOR DISAPPROVAL:
/yi^ 4 m^^^j a^ ^ww^s-
Plot Plan on reverse side
Lot Line
bat w ow sfcYKW
1.
2.
3.
4.
5.
6.
7.
Name of Frontage Road C.J
IMPORTANT
DETAILED PLOT PLAN
IS NECESSARY, FOLLOW
STEPS 1-7 (a-0) COMPLETELY
Name the frontage road and use as a guideline, fill in the lot dimensions and indicate North (N).
Show the approximate location and size of the building.
Show the location of the well, septic tank and drain field.
Show the location of any lake, river, stream or pond if applicable.
Show the approximate location of other existing structures.
Show the approximate location of any wetlands or slopes over 20 percent.
Show dimensions in feet on the following:
a. Building to all lot lines
b Building to centerline of road
c. Building to lake, river, stream or pond
d. Septic / holding tank to closest lot line
e. Septic/holding tank to building
f. Septic / holding tank to well
g. Septic / holding tank to lake, river, stream or pond
h. Privy to closest lot line
i. Privy to building
j. Privy to lake, river, stream or pond
k. Drain field to closest lot line
I. Drain field to building
m. Drain field to well
n. Drain field to lake, river, stream or pond
o. Well to building
Submit To: Bayfield County Zoning Department, PO Box 58, Washburn, Wl 54891
u/forms/sanitary/bayfieldcountysanjtaryapplication
Revise: June 2018 Proofed by:
PORTABLE RESTROOM SERVICING CONTRACT
Contract Date:
'7-2^-ZoZ3 This contract is made between the
Portable Restroom Owner(s) Name(s):
|L»JftUS c^^U^; V\^t6T<^^^
Pumper's (Service Provider) Name:
<s!o. 2 SEPT ic
We acknowledge
PROJECT
LOCATION
the placement of a Portable
Legal Description: (Use Tax Statement)
-1/4,
Gov'tLot I"r'Lot #
_i
1/4,of Section ^. f , Township
CSMff22^0 Vol. Page
Restroom or
TaxlDtt
N,Rangi
CSMDocff
the following property:
3')oZI
w
lot(s) tt Block(s) ff
Town of:
^r(WT>
Subdivision:
v ^Ljj_
Lot Size
A^_
Acreage^
1. The owner agrees to file a copy of this contract with the Bayfield County Planning and Zoning Dept. as required in
Title 15 of the Bayfield County Zoning Ordinance.
2. The owner agrees to have the Portable Restroom serviced by the pumper and guarantees to permit the pumper to
have access and to enter upon the property for the purpose of servicing the Portable Restroom. The owner agrees to
maintain the access road or drive so that the pumper can service the Portable Restroom with the pumping equipment.
The owner further agrees to pay the pumper for all charges incurred in servicing the Portable Restroom as mutually
agreed upon by the owner and pumper.
3. The pumper whom has signed the pumping agreement agrees to submit the agreement to the local government unit
(Bayfield County Planning and Zoning Dept.) as required by Title 15 of the Bayfield County Zoning Ordinance, a
report for the servicing of the Portable Restroom on an annual basis. The pumper further agrees to include the
following in the annual report:
a. The name and address of the person responsible for servicing the Portable Restroom;
b. The name of the owner of the Portable Restroom;
c. The location of the property on which the Portable Restroom is installed;
d. The dates on which the Portable Restroom was serviced;
e. The volumes in gallons of the contents pumped from the Portable Restroom for each servicing;
f. The disposal sites to which the contents from the Portable Restroom were delivered.
4. This agreement will remain in effect until VnejfWBSbSS. pumper terminates this contract. In the event of a change in
this contract, the owner agrees to file a QgSy^ASVy^SQges to this service contract and/or a copy of a new service
contract with the local government untyi^g^peM'Coifffi^anning and Zoning) named above within (10) business
days from the date of change to this s^Q!p'cyf^9cfl L.'-'.^
Owner(s) Name(s) (Print)
(L^v^ V^tsTC^
Pumper's Name^Print),
0(,Ta'^^
Wifiz^ ^(/w^
Pumper's Registration Number^^<
Subscribed and sworn to me on this date:
^•A^iL_^2
/ I Today's/Wr^^^
ws' ^/!sK^ S
)l-^w
Commission Expiration
Created: Nov2011 (Bayfield County Zoning-mff) 06/7/2018
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (t)(m)]Proofed by: KLK
Real Estate Bayfield County Property Listing
Today's Date: 7/25/2023
Property Status; Next Year
Created On: 7/6/2023 8:39:40 AM
•^ Description
Tax ID:
PIN:
Legacy PIN:
Map ID:
Municipality:
STR:
Description:
Recorded Acres:
Calculated Acres:
Lottery Claims:
First Dollar:
ESN:
Tax Districts
1
04
021
041491
001700
Updated: 7/6/2023
39021
04-021-2-44-06-27-4 05-012-11000
(021) TOWN OF GRAND VIEW
S27 T44N R06W
LOT 1 OF CSM 2280 LOCATED IN GOVT
LOTS 11 & 12 IN DOC 2023R-599200
3.900
3.509
0
No
114
Updated: 7/6/2023
STATE
COUNTS
TOWN OF GRAND VIEW
SCHL-DRUMMOND
TECHNICAL COLLEGE
Ownership
RONALD HELSTERN 3R
JULIE HELSTERN
Billing Address:
RONALD HELSTERN JR &
JULIE HELSTERN2697A 7TH ST
CUMBERLAND WI 54829
Site Address * indicates
N/A
Property Assessment
2023 Assessment Detail
Code
N/A
2-Year Comparison
Land:
Improved:
Total:
Updated: 7/6/2023
CUMBERLAND WI
CUMBERLAND WI
Mailing Address:
RONALD HELSTERN JR &
JULIE HELSTERN2697A 7TH ST
CUMBERLAND WI 54829
Private Road
Updated: N/A
Acres Land Imp.
2022 2023 Change
0 0 0.0%
0 0 0.0%
0 0 0.0%
* Recorded Documents
B CERTIFIED SURVEY MAP
Date Recorded: 5/31/2023
B WARRANTY DEED
Date Recorded: 4/14/2023
Q PERSONAL REPRESENTATIVES DEED
Date Recorded: 4/25/2022
Q TERMINATION OF DECEDENT'S INTEREST
Date Recorded: 11/17/2021
63 TRANSFER ON DEATH DEED
Date Recorded: 8/9/2021
Q CONVERSION
Date Recorded:
Updated: 3/15/2006
2023R-599200 V.13 P.165
2022R-594355
2021R-592094
2021R-590207
Property History
Parent Properties
04-021-2-44-06-27-4 05-012-20000
04-021-2-44-06-27-4 05-012-10000
Tax ID
16773
16775
284-365;579-101;754-400
HISTORY E3 Expand All History White=Current Parcels Pink=Retired Parcels
63 Tax ID: 16775 Pin: 04-021-2-44-06-27-4 05-012-10000 Lea. Pin: 021106102000
B Tax ID: 16773 Pin: 04-021-2-44-06-27-4 05-012-20000 Leg. Pin: 021106010000
39021 This Parcel T Parents ^Children
Town, City, Village, State or Federal
Permits May Also Be Required
LAND USE-X
SANITARY - Portable Privy
SIGN -
SPECIAL -
CONDITIONAL -
BOA -
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
No.23-0343 Tax ID: 39021 Issued To: Ronald & Julie Helstern
Location:74 Of % Section 27 Township 44 N. Range 6 W. Town of Grand View
Gov.tLot Lot 1 Block
11 & 12 IN DOC 2023R-599200
Subdivision CSM#2280 LOCATED IN GOVT LOTS
For: Recreational Vehicle (RV)
Make: Patriot Model #: Forest River Vehicle #: 4X4TCKB26KX136989 Year: 2019
(Disclaimer): Any future expansions or development would require additional permitting.
May not be used for permanent residence.
Condition: Allowed for up to 4 months Must be removed by 2/4/2024
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.
Mckenzie Slack, AZA
Authorized Issuing Official
October 4, 2023
Date