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117 E 61h Street PO Box 403 Washburn, WI 54891 (715) 373-6109 pennitsta bavfieldcounty.wi.gov JIM FIELD RECEIVED 0ENERE9NOV 13 2025 Health Zoning Submission # StR-°°33I Fee Paid Refund Permit/I - O O Date Issued 1 of,1' P'a, Short -Term Rental Application Packet This application packet contains information for both a Tourist Rooming 1 -louse license through Bayfield County Health Department and a Short -Term Rental permit through Bayfield County Planning and Zoning Department. Completed application and applicable fees can be mailed/emailed to the address/email above. City of Washburn, City of Bayfield, Town of Pilsen: License through Bayfield County Health Department is required. Please review and fill out pages 1-4. All Other Towns: A license through the Health Department and permit through the Planning and Zoning Department are required. Please review and fill out pages 1-5. SECTION A: ESTABLISHMENT INFORMATION Establishment Name The Nest Establishment Tax ID # 1996 Town/City of barnes Establishment Street Address 3430 Twin Bay Road City Barnes State WI ZIP 54873 SECTION B: OWNER INFORMATION Property Owner Todd R and Lea D Culliton Email Address Icullitonl9@gmail.com Phone Number 6082357706 Owner Mailing Address 49135 E Shore Rd City Barnes State WI ZIP 54873 SECTION C: IF OPERATING WITH PARTNER OR AGENT Legal Licensee (partnership, LLC, LLP, or Inc.) Email Address Phone Number Licensee Street Address City State ZIP Agent Name (if applicable) Email Address Phone Number Agent Street Address City State ZIP SECTION D: RENTAL UNIT INFORMATION (see key below) Unit Unit ID Structure Type Heating Source Water Source Sanitary Source # of Stories # of Bedrooms # of Bathrooms D P P P 1 2 1.5 2 3 4 Structure Type: House Duplex (D) Cabin (C) Yurt Apartment (A) Condo CO Other (0), please describe Heating Source: Electric E Natural Gas G Propane (P) Wood Fuel Other (O), please describe Water Source: Public/Municipal (M) Private Well (P) Sanitary Source: Public/Municipal (M) Private Onsite Wastewater System P Site Plan Show location of: ❑ Driveways O Frontage Roads (include name) O Existing Structures ❑ Well (W) ❑ Septic Tank (ST) ❑ Drain Field (DF) ❑ Holding Tank(HT) O Lake O River O Stream/Creek ❑ Pond O Flood lain ❑ Wetlands O Slopes over 20% ❑ N tI7-- NOVThQ 13 Z025 Bayfield Co. Planning and Zoning Agency Setbacks from furthest extent including eaves and County Use Only overhangs of structure to: Verified setbacks Road Centerline I Z ft. ft. Notes/Comments: Front Lot Line/Right-of-Way I I ft. ft. Side Lot Line 1 ft. ft. (NorthDEasSouthDWestDcheck one) ZS Side Lot Line 2 ft. ft. (NorthEastDSouthDWestD check one )tear Lot Line o ft. ft. Septic/Holding Tank Zoo ft. ft. Drainfield ft. ft. Privy ft. ft. Well ( ft. ft. Existing Structure/Building ft. ft. Wetland ft. ft. Elevation of Floodplain ft. ft. Ordinary High -Water Mark (OHWM) ft. ft. NOTE: Please indicate "see attached" on this page if submitting site plan as a separate document. Bayfield County Health Department — State Lodging License Health Department (State Lodging License): All rental units require a Tourist Rooming House license through the State of Wisconsin Department of Agriculture, Trade and Consumer Protection (WDATCP) or their authorized agent (Bayfield County Health Department. ➢ Bayfield County Health Department issues permits on behalf of the State of WDATCP under ATCP 72, 73, 76, 78 and 79. > ATCP 72 regulates lodging facilities including hotels, motels and tourist rooming houses. ➢ Bayfield County Ordinance Title 9 — Chapter 2 Food Protection. Lodging, Pools, Campgrounds. Recreational/Educational Camps, Tattoo and Body Piercing Establishments outlines the licensing program and the authorized agent agreement between the Bayfield County Health Department and the State of Wisconsin. > ATCP 72.03(20): "Tourist rooming house" means all lodging places and tourist cabins and cottages, other than hotels and motels, in which sleeping accommodations are offered for pay to tourists or transients. It does not include private boarding or rooming houses not accommodating tourists or transients, or bed and breakfast establishments regulated under Ch. ATCP 73. > Wis. Stat. § 97.67 (5) and § 97.605 (1)(c) "No license may be issued until all applicable fees have been paid." > Wis. Stat. § 97.605 (1)(a) "No person may conduct, maintain, manage or operate a hotel, restaurant, temporary restaurant, tourist rooming house, vending machine commissary or vending machine if the person has not been issued an annual license by the department or by a local health department that is granted agent status under s. 97.615 (2)." > Within 30 days after receiving a complete application for a license, the department or its agent shall either approve the application and issue a license or deny the application. If the application fo]i�S.denied, the department or its agent shall give the applicant reasons, in writing,for the denial. FFZZ C' LUJ > A license shall not be issued to an operator without prior inspection. NOV 132025 > Tourist rooming houses license expires on June 30'. ATCP 72 requires an annual rpp M4 - Jg �i,Rp,q d fee. Failure to maintain proper permitting will result in penalties. Licenses are non -transferable, except to immediate family members as allowed in ATCP 72. APPLICATION FEES — Required for all tourist rooming house within Bayfield County Check or money order payable to Bayfield County Health Department When will your rental be in operation: ❑ Summer ❑ Winter O Year -Round O $575 — License Fee ($275) + Pre -Inspection Fee ($300) Pre -Inspection Fee includes bacteriological sample analysis for private drinking water supply. ❑ Rush Fee ($50) — A one-time $50 rush fee will be charged for inspections requested within 7 business days. However, depending on scheduling, staff may not be able to accommodate all rush requests. Your signature below will acknowledge you have received information as to where to obtain a copy of the code and will comply with applicable Wisconsin Administrative Code(s). Personally identifiable information you provide may be used for purposes other than that for which it was collected (Wis. Stat. 5 15.04 (lim11. Signature: Date: n 11A2/25 Bayfield County Planning and Zoning Short -Term Rental Permit PLANNING AND ZONING QUESTIONS 1. Is the property in the shoreland, within 300 feet of a river/stream OR landward side of floodplain OR 1000 feet of a lake/pond/flowage, whichever is greater? ❑ Yes El No O Unsure 2. Is there a wetland located on the property? O Yes O No O Unsure 3. Is there a floodplain located on or near the property? O Yes O No O Unsure 4. Is this project associated with any of the following: O Rezone O Conditional Use ❑ Special Use ❑ Variance 5. Did you contact the town to see if any ermits/re uirements apply to your project? El Yes O No Zoning Department Use Permits: Short -Term Rental permits through Bayfield County Planning and Zoning Department are non -transferable, except as per the exemptions identified in ATCP 72.04(3). Short -Term Rental permits are regulated by Bayfield County Ordinance Section 13-1-35. APPLICATION FEES Check or money order payable to Bayfield County Planning and Zoning 1 unit : $500 2 unit : $1,000 3 unit : $1,500 4 unit : $2,000 To ensure your application is complete and can be processed by the Department, check you have the following items: O Applicant Information (Page 1) O Site Plan (Page 2) O Floor Plan(s) — Provide sheet for each floor within each unit. El Fees paid 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 that I (we) are providing and that will be relied upon by Bayfield County in determining whether to issue a permit. I (we) further accept liability which may be a result of Bayfield County relying on this information I (we) are providing in or with this application. I (we) consent to county officials charged with administering county ordinances to have access to the above -described property at any reasonable time for the purpose of inspection. Owner(s) or Authorized Agent Printed Name: LEAD CULLITON Owner(s) or Authorized Agent Signature: 2) (L"-- Date: NOTE: If you are signing on behalf of the owner(s) a letter of authorization must accompany this application. Nov 13 2025 Pk�nnin Sayfield Co. 9 and Zoning Agarsy r I- WAM Im BSSA 4r- REOEIflD Stock No. 26273IUL 15 ZUU.1 BAYFIELD CO. CERTIFIED SURVEY MAP NO. LOCATED IN GOVT LOT 4, SEC 16-144N-R9W, TOWN OF BARNES, BAYFIELD COUNTY, WISCONSIN (PART OF LOT I, VOL 3 CSM • P 242.243) N 8924729'E NW CORNER I NW CORNER SEC. IB-44.9 j G.L 4 U. 3 PIPE I EX. 11/2' PIPE (OD) (0D) m a m ° WI PT. OF III ..l._171,. P. 6J0 N 0 NI � O O BEARINGS ARE REFERENCED TO NORTH LINE OF SEC 16 - ASSUMED TO BEAR N89°.39' -09'E SCALE -I'=I50' 0 ISO' 300' _JEP_L PGLLINOT•OIL uEOt_ NOV 7 3 ?025 Flanning� Zinn3 ,�.��,,, SrBA_ V Ip `04°E / .L-8 UR. P p4z. 468.43• BPD, 0/. / J38.43. Jy/ �7 I TOTAL AREA 271,060. SQ. FT. A 6 34 AC A LES+ ROADWAYS ESS,S43 W Pr! 5.87 AC.} 3140-!O -w ire G88 oIN ---'JW11 ..Jfl- NBB°-37 9W CORNER B. L. 4 X. GUN BARREL 415 044 _ Es +4R9A1 v —'r. _JELL £flT11__ LAN°•_� ,A� Sam "PA -• EX. IRON PIPE MON. .l� AS NOTED ANE A. MARTEN 0 . SET I' X 24" IRON PIPE • (0. D.) 9-1029t r SOLON SPRINGS MIN. WT. 1.13 LBS./LIN. FT. t9. _WIS'w4A (A' _'L IS1M +4L-.zaZ OJ 643.47' B43 ,47� SE CORNER O.L. 4 EX. 3/4' ppE (0.0.1 SHEET _LOF 2,. • • C■a■�nu C• 'nss :: LL'■LC■■CL.' L"'CCCC"CC nn•u.i■■m■■.■■■■■■ ra■■■Li■ ■■■ ■ ■■ .Cnr so■■■CL '.■ri■■■F amsm MECCCC: :CCLCC�LLC :LL : CL:• . ■■■■ ...m■s■■■■■ ■■ t■■■u■■■ ■■■■ ■■ .C ■■■■■.■■..■..■C...■...C.■u.... .CC.■ •■ ■ ■ ■■ ■■m■■■■■■u■■s■■■C■ ■. ■�■ uuu. ■u�CCaCuC.■C■ ■■■■ .i19■■■■■■■■■..■■.■■■L■ ■C■■■■■■ !iu■.�n ■��■■■C.. I■■uuu■■■■■■.■■■■nns■■■■C It ■ �. �■vn�.■■■R M ■■■■■■■■■■■■■■■..■■■■■■ • 'u''::\�9:' '■■.LLB■C ■L C' • • �•��- - u.....�n■CCL - Lu...■■■■■■■C■CCL■■■■■■ CCLC■. C■.C■.r'u■■■m■..�6■_■■.■. .u. u.. u■.� �•�_:.C'..C....C. ■■■ ■■■.C•■ ■■. .■■■.■■ ". 'ff�:..CL ■C . ■'�■'u'a'iiC■i'�'■mi.i Q;.• ■■■ ■■.. ■u■■■n.■■mnun■.ItaE■■.■■ nu ■■�. ■ �7H■■■■■■u■■■■■■■■■■■■■■■�ilti■�ti�i ■■��■■■ u..■ ■rs3.u■®■■uu■■■.■■■■na■■a*sC■ri■■■■■.■ nnunnun__usuunnnnnnnnsaSwurnruuuun ■1n .LCLLL■■■■■ .■■■■■� �'1.�A/i■. (/il■Lunu ■L■■ 'uu .0 moomn"in■L■■■uC■■0 :C .ra.. i:L. 'L:: LB! C LL: !l CL. p - - - ' Lori ■■C■ ■ ,■C•® i■■ ■ ■■■L ■ r . : ■�"i- rnC■' ...■ �...■ ■Lu ■C■L ... __ . v u• -- iiC■. O.■.■■n■L■■ 6-r ! I I I I l i l! T- IF 11 tF---J r- 3 IHHH rLc C.' ? LkJ C .■ C.u. ■Cinu CC '1. ■u.� C UIIIIF.IIIIJhiiia - - :ii■■ .... Ii r'■ CC. ■.■.C'.' __ :: C Vl. '!' ■ INS �C.__ • ■ ui■i ii -__ ■ ■■' ■.ii _ -�! .■;■ C IIIjulI� E .. fi AFFIDAVIT OF AUTHORITY NOV 13 2025 (Trust) Plannin savri"I j Co Ban , PURPOSE. This Affidavit of Authority is used to certify the individual submitting an application authorized when the property is owned by a Trust. STATE OF WISCONSIN ) ss. BAYFIELD COUNTY The undersigned affirms and states as follows: 1. Address of Subject Property: 3�3 0 1u i A t& ? a. nec W ( !-T 2. The Subject Property is owned by Ddd . Cut t tA. Let O. C "«` (Name of Trust) 202.4 3. The name(s) of the current Trustee(s): Dci 4 . C. LUr 0-`^ L -t 4. I certify that the Trust named in paragraph 2 is valid and in effect on the date signed below. I am the duly appointed agent of the Trust named above in paragraph 2, and I have the authority under the terms of said authorization to submit an application to the Bayfield County Zoning Department concerning the Property described in paragraph 1. I further certify that the information and statements made within this affidavit are true, accurate, and complete to the best of my knowledge. 5. I am authorized by the above -named Trust to apply for and bind the Trust to the terms and conditions of any decision or permit that may be issued by the Bayfield County Zoning Department. 6. By signing this affidavit, I attest that I am unaware of any known or unknown person(s) who would contest this application. I agree to indemnify Bayfield County or such person or legal entity suffering a damage resulting from any illegalities of the application. Dated: L Print Name Subscribed and sworn to before me this 3 1 day of CDC -C71 -PST , 20; Notary Public, County, Wisconsin My commission: PROCESSING INFORMATION INITIAL PROCESSING. Once the department receives your affidavit, the department will review it for completeness. If the information is not complete, the department may reject your affidavit and the application. REQUEST FOR MORE INFORMATION. The department may request that you provide more information or evidence to support your affidavit. DECISION. The department will review all documents submitted as part of the application for registration and title, this form included, and may approve, deny or request more information. RECEi!<ED Nov 732025 PJanni BaYfieltl Co. n9 antl Zoning Agency Sawyer County Environmental Health ADDRESS: 10610 Main Street, Suite 224, Hayward, WI 54843 PHONE: (715) 634-4806 x 2438 FAY.: (715) 634-5019 V WEB:are only acce pted Mondey-Thursdaip/ htt /wwwsawyercountygov.org/511/DrinkingWell-Water-Testing JSAWYEROSHKOSH �/ Samples y , um.emlrymwi,cnnq" 8:00 am to 2:00 pm Stevens Point.. ter TI m Bacteria $30 owners Pkg $75 Metal Test $50 (Metals Pkg $100 iCollform Bacteria & e. Coll) (Retest of a single metal element) (Arsenic,Calcium, Copper, her, Lead, Maeneslum, Manganese, Potassium, Sodium, Sulfate, Zinc, Phosphors,( (DComprehensive Homeowners $150 (Homeowners Pkg. Metals Ptg) (JJitmte $50 Collection Dater/_jj z�' Time: \:Q :Q (am/pa). of Person Taking The Sample: Mail Report to: Name:eLeL I _ r . t • �^ PO Box: Address: 4 G j 3 5 C.(_ 4 City: State: ySLjIP: 5 813 Home Phone: Cell Phone: CO nsz — Z? 55 — 1� \dditlonal Reporting Options: Please Provide Email Address. IA Well Owner Information: ❑ Same as Report to Name & Address Name:�rc r�q �. d f`��r M Addrests':jit-3o —S— f 7, - City:—`. r•n-�-s State:..j Phone:"}t `i' £ 83 \8'I. Water Sample Physical Address: <Same as Well Owner Address out ONLY If Pump Work/Maint, or New Well Installed: WI Unique Well Nur Collected By:_ DATCP Lab Cert. ID #: 471013 WDNR Lab Cert. ID # 105-519 Reason for Testing: """°"'°"`tI,Pumpwor ^w"!enanceenMWw. peace fill outthe section on the bottomlen side alibis ❑ Annual Test sheet 0 Pump work/maint, or new well O Required by Lender/Real Estate ❑ Retest of positive bacteria test ❑ Suspect water quality problems ❑ Retest follow well disinfection ❑ Curious about water quality rrnst..., 0 C— 7 _ ❑ Infant/pregnant/daycare Sample Source: ' itchen Tap (PK) ❑ Pressure Tank Tap (PP) 0 Bathroom Tap (PT) 0 Milk House (PM) ❑ Basement Tap (PE) 0 Laundry Tap (PL) ❑ Sample Faucet (PD) n rich.,, fort 0 Outside Tap (PH) Problems Observed: Last Date Tested: 0 Retest ❑ Color ❑ Taste ❑ Odor ❑ Never %inknown ❑ 1 year ❑ Corrosion ❑ Health None ❑ 1-2 years ❑ 2-5 years ❑ Ot¢cr n ctn „e,r.. _Tian. years WELL WATER SAMPLE RECEIVED Date I; Y itials: Date: U, Time: / / ( Wate " Lraccepted ❑ Rejected Initials:TC my Bacteria ID: S L l 0 bator In Date: ii'itJfl Time 2zs2lam,® bator Out Date: J±JJ.J251, Time 0o(am/�iR iform Result: "e) .0 .. Present (Unsafe) olifnrm Prpcont' n c ,-.,n A _ _ P - _ AB USE ONLY ❑ RUSH Date Received: _/___/ Time:. _ (am/pm) R01: yFS NO PH: Hardness: mg/L Iron: mg/L Alkalinity: mg/L trate 10: Temp: _______ •C pH:Res. Cl:_ mg/L Result: mg/L Date Analyzed: _/_/_______ Date Analyzed:_J_/ Professional License !!: I U, v' VE L 11/12/25, 4:10 PM Septic Search N Name: Site Address: Mail Address: Management Level: Service Provider ID: Service Provider: Report Filed By: Component that was pumped, inspected or maintained: 1: Septic Tank Septic/HoldingTankGallons Pumped: Total Gallons Pumped: Last Report Dates Inspection: 9/3/2019 Maintenance:! None Filed Pump: 10/31/2025 Date Serviced: Date & Time Disposed: Disposal Location: Gallons Disposed: Waste Type: IRMGARD BERGMANN 3430 TWIN BAY RD Barnes, WI 3430 TWIN BAY RD Solon Springs, WI 2059 HK Septic Service Kevin W. McKinney RECEIVED NOV 13 2025 Bayfield Co, 1200 Planning and Zoning Agency 1200 Lid Depth Septic Tank: Lift Tank/Siphon Chamber: Aeration Unit: 10/31/2025 10/31/2025 Home Field 1200 None Selected This report only describes the conditions at the time of service and under the conditions of use at that time. This report does not address how the system will perform in the future under the same or different conditions of use. Carmody, Compass and Septic Search are independent business entities and are not associated with business practices or liabilities assumed by the inspection, inspectors and or their business entities. "This is a copy of an electronic document generated from Carmody. https://septicsearch.com/Property/Pump.aspx?ha=1&hi=l&po=l&id-2196579&permit id 215919 1/2 ID: A6685DC2-E7DF-4783-8B83-E7B36741 CFDE 19--� Consumer Financial Protection Bureau PRIVATE ONSITE WASTE TREATMENT SYSTEMS � sconS1/7 ( POWTS) Department of Commerce INSPECTION REPORT Salary and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION - .. _ '--_--_..__,,e__----------- Ic ntllVmll peiv4.Hnlnees Name: ? CDy Village 7 own 'S ev: nsp gv: BM Description: IIa1: G�1:17Q:11,h�lliJ: I TYPE MANUFACTURER CAPACITY Septic 2 1 C Dosing Aeration Holding fi1;i:caI?id3Crf4 NIII!:%IIP); TANK TO Pit WELL BLDG VTTO AIR INTAKE ROAD Septic N. J3,S NA Dosing NA Aeration NA Holding r PUMP I SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia Dist. To Well DIMENSIONS Width 3 Lenglhg$' NooiCeils 2, SETBACK P / L Bldg Ne'I OHWM a Nev INFORMATION Waters CELLTO dGWG' n- Header/ Dia Depth Over Depth Over Dia COMMENTS: (Include code discrepancies, persons present, etc.) Z%b<t A-IoO 2- raves o- 14 c�V...,..1a Nom CLCVMI IIJI1 1 11M STATION BS HI FS ELEV Benchmark 1.94 /; y (D, ` Bldg. Sevier z?• 9?. /; St/Htlnlet -S '. / " St/ Ht Outlet (0.'73 yi. Z / Dt Inlet Dt Bottom Installation Contour Header/Man. 7.2.4 4162 Dist Pipe 7• lb 'p1. /X Infiltrative Surface g.2'/ ',"3.70 Final Grade S• : y c''i o4 eccL..._L.r 2,9.90 'z.y 72 Q.$ c 'c/c. __ County Ad Sanitary Permit No: 404315 State Plan Transaction ID#: Parcel Tax No: Type of System LEACHING Manufacturer: j4�. 1D CHAMBER Model Number: X Pressure Systems Only X Hole Size X Hole Observation Pipes Soacino ❑ Yes ❑ No NOV 13 2020 Planning Plan revision required?O Yes D No — / OS Lk. w, . Use other side (or additional information Date POWTS Inspectors Signature Carl No Bureau of Field Operations, PO Box 73D2, Madison, WI 53701-7302 snnR7dn (P vml Docusign Envelope ID: A6685DC2-E7DF-4783-8883-E7B36741 CFDE BORROWER CONSENT TO THE USE OF TAX RETURN INFORMATION Borrower(s): Todd R Culliton Lea D Culliton Property Address: 3430 Twin Bay Rd Barnes, WI 54873 Lender: Paramount Residential Mortgage Group, Inc. I/We, Todd R Culliton AND Lea D Culliton Date: October 31, 2025 Loan Number: 4256185002 understand, acknowledge, and agree that the Lender and Other Loan Participants can obtain, use and share tax return information for purposes of (i) providing an offer; (ii) originating, maintaining, managing, monitoring, servicing, selling, insuring, and securitizing a loan; (iii) marketing; or (iv) as otherwise permitted by applicable laws, including state and federal privacy and data security laws. The Lender includes the Lender's affiliates, agents, service providers and any of aforementioned parties' successors and assigns. The Other Loan Participants includes any actual or potential owners of a loan resulting from your loan application, or acquirers of any beneficial or other interest in the loan, any mortgage insurer, guarantor, any servicers or service providers for these parties and any of aforementioned parties' successors and assigns. ACKNOWLEDGEMENT By signing below, you hereby acknowledge reading and understanding all of the information disclosed above, and receiving a copy of this disclosure on the date indicated below. TODD R CULLITON DATE LEA D CULLITON DATE ©2019 The Mortgage Industry Standards Maintenance Organization. All rights reserved. ICE Mortgage Technology, Inc. L00000BCTAXRIJ 0520 GBCTAXRIJ (INI) 10/31/2025 03:05 PM PST Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �seonsin Madison, WI 53707 - 7162 Site Address 3qq0 Department of Commerce 3450 Two Sanitary Permit Application In Comm 53.21, Wis. P , /5 accord with Adm. Code, personal information you provide 0 Chxk if Revision may be used for secondary Privacy Law, 315.04(l)fm) I. Application Information - Please Print All Information RE + 1 V ED State Plan I.D. Number Property Owner's Name JUN 1 O R 003 ill GU Parcel Number ,o,/._ o //4F/_ 03 99/ Property Owner's Mailing Address 3z2-sw- ,'• ✓� 4Pd Properly Loeadat,,Grv. City, State Zip Code Phone Number ME '4lt: S /6 T N. R4 a Lot Number Block Nor �s , Nl1 54$7 3 715—79 s•�.6oib CSM Number U. Type of Building (check all that apply) Qciry ® 1 or 2 Family Dwelling - Number of Bedrooms ..._. ❑ Public/Commercial- Describe Use ❑Village ❑ State Owned �TowashI V4U'S Nearest Road T 6 �r III. Type of Permit: (Check only one box on line A (numbering scheme for Internal use). Complete line B If applicable) A. 1 g New 2 ❑ Replacement System 3 ❑ Replacement of I ❑ Addition to For County nse 16 stem Tank ON System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that aPPIY)(numbering scheme is for internal use) 44 (Non -Pressurized In -Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Weiland 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 4S ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DlspersaljTreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Miniinch) Elevation T/.. 00 9�g,7 O�O Q,� a ( nA+ T.2• g0�� ��� 9fa.1 VI. Tank Info Capacity in Tool Number Manufacturer Gallons Gallons of Tanks Prefab Site Steel Fiber Plastic Now Faciadttg Concrete Constructed Glass Tanks Tucks Seale or Hollins Tank /oZSO O /o? SO t�dag C camber IL,Gr VU. Responsibility Statement- I, the trade d,assumerespemn,wty for hutalladon of the POWTS shorn an the attached plans. Plumber's Name (Print) 'S Si 7IRS Number s Z). �4`vs�s Business Phone Number Z� �� '' umber's Address (Street. City, State p code) I %/S'P 745- a7T 94(S6 $,4 ,€ old ' raga, Utl! S�8y3 VIII. Countymepartent Use Only Approved 0 Disapproved I S5flIsaLY Permiti Fee (Includes Groundwater charge Fee Date Issued Luultlg /agent Signature (No Stamps) ❑ owner Govan Imaal Adverse ,{;+ Determination..�. � "� (7j 1Z, //'/o3 _ ,, 11. Conditions of Approval/Reasons for Disapproval () (to else Canal, a..t t ae. it.. .� ..__ s. — _ — -- 1•W^ —... w..rs. vu. w as N{cacs I I SBD-6398 (R. 05/01) - Docusign Envelope ID: A6685DC2-E7DF-4783-8B83-E7B36741CFDE PRMG 1 i Paramount Residential Mortgage Group, Inc. 1 ACKNOWLEDGMENT OF RECEIPT OF YOUR HOME LOAN TOOL KIT CHARM HANDBOOK Property Address: 3430 Twin Bay Rd Barnes, WI 54873 Borrower Name(s): Todd R Culliton / Lea D Culliton Broker/Lender: Paramount Residential Mortgage Group, Inc. I/We have received a copy of the CFPB's "Your Home Loan Toolkit" within three (3) days of applying for a mortgage loan as required by the Real Estate Settlement Procedures Act (RESPA) and the TILA-RESPA Integrated Disclosures Rule (TRID). A copy of the "Your Home Loan Toolkit" can also be found at: http://files.consumerfinance.gov/f`/201503 cfpb your-home-loan-toolkit-web.pdf If applying for an adjustable rate mortgage loan: I/We have also received the "Consumer Handbook on Adjustable Rate Mortgages" (CHARM) within three (3) days of applying for an adjustable rate mortgage loan as required by the Real Estate Settlement Procedures Act (RESPA) and the TILA-RESPA Integrated Disclosures Rule (TRID). A copy of the "Consumer Handbook on Adjustable Rate Mortgages" can also be found at: http://files.consumerrinance.gov/f/201401 cfpb booklet charm.pdf ACKNOWLEDGEMENT By signing below, you hereby acknowledge reading and understanding all of the information disclosed above and receiving a copy of this disclosure on the date indicated below. Borrower Date Co -Borrower Date • Rev. 5/19/2021 wmconsln Department of Commerce SOIL EVALUATION REPORT 1400geL _ Division of Safety and Buffdings in accordance with Comm 85, Wis. Adm. Code minty Attach complete site plan on paper not less than 8112 x 11 Inches In size. Plan must Include, but not limited to: vertical and horizontal reference point (Brit), direction and Parcel l.D. percent slope, scale or dimensions, north arrow, and location and distan a to r tiroal. 4�fi-1,11 0,3 3i9/• Please print all Information. evievred Date Personal Information you provide may Ise used for oa )}Ct i2Jk> i C _ /2, Property Owner Props Lion ( ) � rri�.�e ` JUN 1 0 WVLLA 1/4 NW 1/4 S Property Owner's Mailing Address Lot # lock # Subd. Flame 3Z2r step C+o r. eld Co. Nil g Delp o, arvo7g6 Cityyy�� State p e P Number 0 City ❑ Village (�Towr i.WI'iPeS sir (7/S)7s-zS2 C)3 T 'ifs N R 9 8 :) W Pitta Nearest Rodd I New Construction Use: ® Residential I Number of bedrooms Code derived design flow rate GPO ❑ Replacement [] Public or commercial - Describe: Parent material Flood Plan elevation if applicable spa.. ft. General comments and recommendations: Qom SO & <bb #'3 /7 tO 1 T-/ IRMIMENED II n Ta g'?' JUN 1_ p 2003 Boring # ❑ Boring • . _4i ® pit Ground surface el8v. _fi ft. Depth In limiting factor in. SoltPPU1tOI Rate Horizon Depth Donlnant Color Redox Description Texture Structure Consistence Boundary Roots ,GPO/f2 In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *E0#2 0• 3 7 e z o S� F✓ �, ✓ as I ,(,& o. o. b Z 3- ti U C. h7v' D. 7 /• Z- 3 a-141 •� d o o sq w, ( as 0.7 I. z-- Boring # ❑ Boring it Ground surface etev. j_ ft. Depth to limiting factor > $6 In. Soli Aflcailon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD11t2 In. Munsell Qu. Sz. Cant, Color Gr. Sz. Sh. *Ett#1 *Eff#2 Q3 o S f rtirs tS o• 2- 4-h " o S O in ( as 9vP-ft �•7 /.Z '.. L .- 3 *4 ts I(2e.r n, # A 4, V. 7 /.z 35_ a 3 't /'' 0.7 i. Z V4 o S os7 at1 — 0.7 1.2 I EI & Mu ire ovvb_UV £&y u►)rI. df[v I O v 7IOU m$/L Please Print) Signature Effluent e2 = 5OD5< 30 mglL and TSS <30 mg/. CST Number )ate Evaluation Conducted Telephone Number 7fS-7'9S-2 77 Docusign Envelope ID: A6685DC2-E7DF-4783-8B83-E7B36741CFDE LOAN #: 4256185002 Housing counselors near you 10 CLOSEST RESULTS TO ZIP CODE 54873 6. 7. 8. 9. Agency Name: KOOTASCA COMMUNITY ACTION, INC. Address: 822 NE 5th Ave, Grand Rapids, MN, 55744-2963 Phone Direct: 218-999-0800 0828 Phone Toll Free: 877-687-1163 0828 Fax #: 218-999-0197 Email: sandyo@kootasca.org Web Address: http:llwww.kootasca.org Distance: 101.99 miles Languages Supported: English Agency Name: ANOKA COUNTY COMMUNITY ACTION PROGRAM, INC Address: 1201 89th Ave NE Ste 345, Blaine, MN, 55434-3373 Phone Direct: 763-783-4747 4851 Fax #: 763-783-4700 Email: accap@accap.org Web Address: http://accap.org Distance: 113.30 miles Languages Supported: English Agency Name: COMUNIDADES LATINAS UNIDAS EN SERVICIO-CLUES Address: 797 7th St E, Saint Paul, MN, 55106-5070 Phone Direct: 651-379-4200 Fax #: 651-292-0347 Email: housing@clues.org Web Address: http://www.clues.org Distance: 118.03 miles Languages Supported: English,Spanish Agency Name: NAVICORE SOLUTIONS-ROSEVILLE, MN Address: 1700 Highway 36 W Ste 510, Roseville, MN, 55113-4027 Phone Direct: 866-472-4557 Phone Toll Free: 866-472-4557 Fax #: 732-863-5052 Email: housing@navicoresolutions.org Web Address: http:/Iwww.navicoresolutions.org Distance: 118.13 miles Languages Supported: English,Spanish 10. Agency Name: NSC (NACA COUNSELING SUBSIDIARY) - MINNEAPOLIS, MN Address: 6300 Shingle Creek Pkwy Ste 145, Brooklyn Center, MN, 55430-2135 Phone Direct: 763-656-6222 Phone Toll Free: 617-250-6222 Fax #: 877-029.6222 Email: service@naca.com Web Address: https:llwww.naca.com Distance: 118.80 miles Languages Supported: English,Spanish ICE Mortgage Technology, Inc. Counseling Services Provided: Pre -purchase Counseling,Pre-purchase Homebuyer Education Workshops Counseling Services Provided: Mortgage Delinquency and Default Resolution Counse,Non-Delinquency Post Purchase Workshops,Pre- purchase Counseling,Pre-purchase Homebuyer Education Workshops Counseling Services Provided: Resolving/Preventing Mortgage Delinquency Workshop,Financial Management/Budget Counseling,Financial, Budgeting and Credit Repair Workshops,Pre-purchase Counseling,Pre-purchase Homebuyer Education Workshops Counseling Services Provided: Mortgage Delinquency and Default Resolution Counse,Financial Management/Budget Counseling,Pre- purchase Counsellng,Rental Housing Counseling, Reverse Mortgage Counseling Counseling Services Provided: Mortgage Delinquency and Default Resolution Counse,Financial Management/Budget Counseling,Fair Housing Pre -Purchase Education Workshops,Non- Delinquency Post Purchase Workshops, Predatory Lending Education Workshops,Pre-purchase Counseling,Pre- purchase Homebuyer Education Workshops Page 3 of 3 GHOMECNSLS 0825 GHOMECNSLS (POD) 10/31/2025 03:05 PM PST ■ r ■ i if■ ■ i ■ C. r t Property Owner 94d Parcel ID # _ D� � //11 —OS 91 °%/ B•Odn9 # Boring Pit Ground surface elev. 44 •7_ ft. Depth to UmlUng factor _In. In. pe=o= A..M�tl�_ R_a_ .Horizon Depth In. Dominant Color Mu nsell Redox Description Qu. Sz. Cont. Color • Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPWft2 'Eifi 1 Eff#2 I o4 7is1IL3o �1 qtr i %V4 IYA' O • o -•G Z. #w, _0 1 s r 0.7 12.. Vn 4s ittf p• IL. 3..89 '' o 3 of — 0.7 I • IBorIng# [f Boring ❑ Pit Ground surface elev._- ft. Depth to tfmiting factor _In. Snn eRrifrseRnn Rata Horizon Depth In. Dominant Color Munselt Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPOW •Eff#1 •Eff#2 . ❑ Boring Boring # Ground surface etev. Depth to limiting facto(_ in. ❑ Pit ft. Soil AnnUmflon Ratff Horizon Depth In. Dominant Colci Munseii Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Shi. Consistence Boundary Roots GPDfft2 'E#f#1 Eff#2 Effluent#1 BODD > 30 ≤ 220 mg/L and TSS >30 < 150 mgfL ' Effluent#2 a BOD,, 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Docusign Envelope ID: A6685DC2-E7DF-4783-8B83-E7B36741CFDE LOAN #: 4256185002 Housing counselors near you 10 CLOSEST RESULTS TO ZIP CODE 54873 1. Agency Name: COMMUNITY ACTION DULUTH Address: 2424W 5th St, Duluth, MN, 55806-1500 Phone Direct: 218-726-1665 Fax #: 218-726-1612 Email: mail@communityactionduluth.org Web Address: http://www.communityactionduluth.org Distance: 31.34 miles Languages Supported: English 2. Agency Name: ONE ROOF COMMUNITY HOUSING Address: 12 E 4th St, Duluth, MN, 55805-3895 Phone Direct: 218-727-5372 Email: nkoiodge@lroofhousing.org Web Address: https://www.1roofhousing.org/ Distance: 31.80 miles Languages Supported: English 3. 4. Agency Name: LUTHERAN SOCIAL SERVICE OF MINNESOTA Address: 1330 E Superior St, Duluth, MN, 55805-3854 Phone Direct: 218-529-2227 Phone Toll Free: 888-577-2227 Email: Issfinancialcounseling@Issmn.org Web Address: https://www.lssmn.org/fiinancialcounseling/ Distance: 31.88 miles Languages Supported: English Agency Name: ARROWHEAD ECONOMIC OPPORTUNITY AGENCY, INC. Address: 702 S 3rd Ave, Virginia, MN, 55792-2776 Phone Direct: 218-749-2912 6895 Phone Toll Free: 800-662-5711 6895 Fax #: 612-486-9060 Email: autumn.holweger@aeoa.org Web Address: http://www.aeoa.org Distance: 85.73 miles Languages Supported: English Counseling Services Provided: Financial Management/Budget Counseling,Pre-purchase Counseling,Pre-purchase Homebuyer Education Workshops Counseling Services Provided: Non -Delinquency Post Purchase Workshops,Pre-purchase Counseling,Pre-purchase Homebuyer Education Workshops Counseling Services Provided: Mortgage Delinquency and Default Resolution Counse,Financial Management/Budget Counseling,Non- Delinquency Post Purchase Workshops,Pre-purchase Counseling,Reverse Mortgage Counseling Counseling Services Provided: Pre -purchase Counseling,Pre-purchase Homebuyer Education Workshops 5. Agency Name: WISCONSIN NATIVE LOAN FUND Counseling Services Provided: Address: 14284 State Highway 70 W, Lac Du Flambeau, WI, Non -Delinquency Post Purchase Workshops,Pre-purchase 54538-9605 Counseling,Pre-purchase Homebuyer Education Phone Direct: 715-588-1600 Workshops Email: INFO@WINLF.org Web Address: http://winif.org Distance: 93.86 miles Languages Supported: English ICE Mortgage Technology. Inc. Page 2 of 3 GHOMECNSLS 0825 GHOMECNSLS (POD) 10/31/2025 03:05 PM PST r ...l6i..%W' O 9b /of a?S O O f Q 'Q '/:;7 -v " -1 0A k L/ M ° p v a7 cA-i, I .'w,fV Y r o'h4 Pt 'S �p19 77 rY af ° ", d 1141 1 r e •c' 9b tao* 0 wso i Docusign Envelope ID: A6685DC2-E7DF-4783-8B83-E7B36741 CFDE HOMEOWNERSHIP COUNSELING ORGANIZATION LIST Borrower(s): Todd R Culliton Lea D Culliton Present Address: 49135 E Shore Rd Solon Springs, WI 54873 Home Counseling Disclosure Date: October 28, 2025 Loan Number: 4256185002 Lender/Broker: Paramount Residential Mortgage Group, Inc. The counseling agencies on this list are approved by the U.S. Department of Housing and Urban Development (HUD), and they can offer independent advice about whether a particular set of mortgage loan terms is a good fit based on your objectives and circumstances, often at little or no cost to you. This list shows you several approved agencies in your area. You can find other approved counseling agencies at the Consumer Financial Protection Bureau's (CFPB) website: http://www.consumerfinance.gov/find-a-housing-counselor/ or by calling 1-855-411-CFPB (2372). You can also access a list of nationwide HUD approved counseling intermediaries at https://answers.hud.gov/housingcounseling/ s/?language=en_US. You can find additional third -party homeownership education providers aligned with the National Industry Standards (NIS) for Homeownership Education and Counseling at https://homeownershipstandards.org/home/ Home.aspx. ICE Mortgage Technology, Inc. Page 1 of 3 GHOMECNSLS 0825 GHOMECNSLS (POD) 10/31/2025 03:05 PM PST -flco 6 e��t Ca, Left s(L-r 'Zc5 wSi�- Croh5 `:,rc; lion of o Iwo Ceti In Ground Component Us•no t eaching Chambers I S�@ !/! � (!�� /H T I /�V'!L �[J i^ �' S T � I�YJ S /ice G ,• I I or G.,.�,ee y too of 0~ s_ . 111 J aI � .; taP o1 drier := S�aw tie,. = - - - - • 4 • a S$ to be ceerlrctt/ a i4 c4 - reNd wrMerifor tioety at Docusign Envelope ID: A6685DC2-E7DF-4783-8B83-E7B36741 CFDE MG Paramount Residential Mortgage Getup. Inc. Important Undisclosed Debt Disclosure October 31, 2025 Loan Number: 4256185002 Borrower: Todd R Culliton Property Address: 3430 Twin Bay Rd Barnes WI 54873 Loan Application Date: 10/28/2025 Your recent mortgage loan application was signed under penalty of perjury, making any false disclosure within it punishable as a crime. You are being asked by this document to confirm you will not take out any additional credit during the processing of your application or if you do need to take out additional credit before your mortgage loan closes, you will notify your loan officer and Lender of the change in your liabilities. It is illegal for a person to knowingly withhold debt obligation information regarding a credit application to a financial institution. Withholding such information is mortgage fraud, which is investigated by the Federal Bureau of Investigations (FBI), and is punishable by up to 30 years in federal prison. I understand and agree to notify my loan officer and lender ill incur any additional debt prior to closing. I/we, acknowledge and certify that I (we) have no other debt obligations that are expected to exist at or around the time of this transaction closing beyond what I (we) provided on my (our) loan application and what is provided above on this document. I (we), further acknowledge and certify that I (we) understand that we are confirming this at this time and acknowledge that knowingly withholding debt obligation information is mortgage fraud, which may be punishable by incarceration in federal prison. Borrower Date Co -Borrower Date This in no way constitutes a loan commitment of approval Rev. 4/2/2024 SEPTIC SYSTEMS MAINTENANCE AGREEMENT � [In -ground (gravity, dosed, and pressure distribution), At -grade, and Mound Systerns)RECE J� •r ED JUN 1 0 2003 Property Owner: 0b (?011-i.- _ I Legal Description: Ja 1- L Cr,.Lai � -NErNIel, x9 i� LS I, Csm 00007% Patna ParcellDfi: 0O5/—//!/— 03 49/ Type of Private (A) In -ground gravity ❑ (D) Mound Sewage System: ❑ (B) In -ground dosed ❑ (E) At -grade ❑ (C) In -ground pressure distribution In the event the minimum standards contained in the applicable Wisconsin Administrative Code can be met, and a sanitary permit is issued for the installation of a code compliant private sewage system, at the above listed location, the owner of the property hereby understands and agrees to maintain the system in a manner prescribed by the Bayfleld County Private Sewage System Code and Comm 83, Wisconsin Administrative Code. (1) Septic tank (System types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. (2) Pump chamber (System types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. (3) Septic tank effluent filter (System types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by Comm 83.55, Ws. Admin. Code. (4) Private sewage system dispersal cell (System types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. (5) Mounds, At -grade and In -ground pressure system laterals (System types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. (6) The owner of the septic system shall furnish the Bayrield County Zoning Department a copy of the inspection report verifying the condition of the tank(s), whether wastewater or effluent is ponding on the ground surface and the date of pumping and other service that was necessary whenever this information is required by the County. Reports shall be signed by properly licensed individuals. (7) When the title to the property is transferred, a copy of this agreement should be furnished to the new property owner(s). This agreement ^ shall be binding on all assignees and heirs. ' Signature o Property Owner U%D,b sDme/Fonus/S,,pt Sys Main% q{Snun 3o fr-a,,, 0.3 �-Date August 2000 Docusign Envelope ID: A6685DC2-E7DF-4783-8B83-E7B36741CFDE Loan #: 4256185002 Notice to the Home Loan Applicant In connection with your application for a home loan, the lender must disclose to you the score that a consumer reporting agency distributed to users and the lender used in connection with your home loan, and the key factors affecting your credit scores. The credit score is a computer generated summary calculated at the time of the request and based on information that a consumer reporting agency or lender has on file. The scores are based on data about your credit history and payment patterns. Credit scores are important because they are used to assist the lender in determining whether you will obtain a loan. They may also be used to determine what interest rate you may be offered on the mortgage. Credit scores can change over time, depending on your conduct, how your credit history and payment patterns change, and how credit scoring technologies change. Because the score is based on information in your credit history, it is very important that you review the credit -related information that is being furnished to make sure it is accurate. Credit records may vary from one company to another. If you have questions about your credit score or the credit information that is furnished to you, contact the consumer reporting agency at the address and telephone number provided with this notice, or contact the lender, if the lender developed or generated the credit score. The consumer reporting agency plays no part in the decision to take any action on the loan application and is unable to provide you with specific reasons for the decision on a loan application. If you have questions concerning the terms of the loan, contact the lender. [ ] Experlan P.O. Box 2002 Allen, TX 75013 1-888-397-3742 www.experian.com [ ] TransUnlon P.O. Box 1000 Chester, PA 19016 1-800-888-4213 www.transunion.com [X] Equifax P.O. Box 740241 Atlanta, GA 30374 1-800-685-1111 www.equifax.com ICE Mortgage Technology, Inc. Page 3 of 3 • . N pII G1CS3J 0418 G1CS3J (POD) 10/31/2025 03:05 PM PST M&$ v. NE, a k), SIC, T*t'/, Je4 w tsar 00079b 6 f.24 L.t PkYIL h'I 8/mil Q•r ® 0M NM I wfY'/ bs7 igrtiet- LL)ioo AJ uo e.J/ f sus Qb F/ 3, 7 to j cf..,i E/. 9d, o 1? '/V se Ua ,a r f-/, (cc. U H if h a;vj ger e& h 2L/ A /n o //4e, - IF SYSTEM FAILS --- You may call one of the following Bayfteld Cowm' Zoi�ng 715.373.6138 CMF Contraction 719.795.2922 Gans i Septic 71 S-634-2394 ;w 9q .s`3o-o3 p Docusign Envelope ID: A6685DC2-E7DF-4783-8B83-E7B36741CFDE Loan #: 4256185002 Understanding Your Credit Score (continued) Key factors that TIME SINCE MOST RECENT ACCOUNT OPENING IS TOO SHORT adversely affected AMOUNT OWED ON REVOLVING ACCOUNT IS TOO HIGH your credit score TOO MANY ACCOUNTS WITH BALANCES Checking Your Credit Report What if there are You have the right to dispute any inaccurate information in your credit report. If you find mistakes in your mistakes on your credit report, contact the consumer reporting agency. credit report? It is a good idea to check your credit report to make sure the Information it contains is accurate. How can you obtain Under federal law, you have the right to obtain a free copy of your credit report from each a copy of your of the nationwide consumer reporting agencies once a year. credit report? To order your free annual credit report — By telephone: Call toll -free: 1-877-322-8228 On the web: Visit: www.annualcreditreport.com By mail: Mail your completed Annual Credit Report Request Form (which you can obtain from the Federal Trade Commission's web site at http://www.ftc.gov/bcp/conline/include/requesttormfinaipdf) v/bcp/conline/include/requestformfinal.pdf) to: Annual Credit Report Request Service P.O. Box 105281 Atlanta, GA 30348-5281 How can you get For more information about credit reports and your rights under Federal law, visit the Consumer more information?. ,. Financial Protection Bureau's website at www.consumerfinance.gov/learnmore. ICE Mortgage Technology. Inc. Page 2 of 3 'it' 4'J• G1 CS3J 0418 G1CS3J (POD) 10/31/2025 03:05 PM PST II- �1 Safety and Buildings Division it')Y County 201 W. Washington Ave., P.O. Box 7162 fz-eCeL �seonsin Department Madison, WI 53707 - 7162 Sim Address 7 of Commerce 34SO iwr Pd Sanitary Permit Application4 itary P`nr,'t"{�/N�umbcr In accord with Corn 83.21. Wis. Adm. Code, personal information you provide be '" -! ,3/ S ❑ Check if may used for second purposes Privacy Law, sI5. l (m Revision I. Application Information - Please Print All Information RECEIVED State Plan LD. Number Property Owner's Name 2003 6elL JUN 1 0 Parcel Number o�r� ao'J- ///l_ 0.3 99 / Property Owner's Mailing Address ///' n 32Z �GLr VI ✓i Ka/ Property LocatioMgy-�G.. Lef'A City. State Zip Code Phone Number A/E SL n/G/ lG: 5 /6 T Y N. R4 I Lot Nu bon Block Number 5487 7/s 79s-a5a6 cS.0 Number o00 79r, fZzra II. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms ❑Ciry ❑ Public/Commercial - Describe Use ❑Village ❑ State Owned Township �Q%/)(S NearestRoad III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 J New 2 0 Replacement System 3 0 Replacement of 6 ❑ Addition to For County use System Tank Only Existing System B. 0 Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 [?Non -Pressurized In -Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Welland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 0 Single Pass 51 ❑ Drip Line 45 ❑ At-Gnde 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation I Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation Gi00 T�- 93.7 870 . 7 n t, r 2 - 9,?. 95. to 96.9 VI. Tonic Info Capacity in Total Number Manufacturer Gallons Gallons of Tanks Prefab I Site Steel Fiber Plastic New Existing Concrete Constructed Glass Tanks Tanks Septic or Holding Tank La 6-O O /07 SO / Dosing Chamber �� VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sigg�natur MP PRS Number orr s D. C,,r"r,4 Business Phone Number vt zzzys lumber's Address (Street, City, State, p Code) p/c- Qc-2t77 ___ e J,4O,e Rs &'nesr i 5c1 -P93 VIII. Count /De artment Use Onl ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Sumps) Surcharge Fee) !%Approved ❑ Owner Given Initial Adverse f 2 - Determination IX. Conditions of Approval/Reasons for Disapproval e p (to the Ccuat ow ) r N r y or a system en paper not less than 81/1 z 11 inches to size SBD-6398 (R. 05/01) Docusign Envelope ID: A6685DC2-E7DF-4783-8883-E7636741 CFDE CREDIT SCORE DISCLOSURE EXCEPTION FOR LOANS SECURED BY ONE TO FOUR UNITS OF RESIDENTIAL REAL PROPERTY Applicant(s): Lea D Culliton Date: October 31, 2025 Loan Number: 4256185002 Paramount Residential Mortgage Group, Inc. Your Credit Score and the Price You Pay for Credit Your Credit Score Your credit score 796 Source: Date: Equifax October 30, 2025 Understanding Your Credit Score What you should Your credit score is a number that reflects the information in your credit report. know about credit scores Your credit report is a record of your credit history. It includes information about whether you pay your bills on time and how much you owe to creditors. Your credit score can change, depending on how your credit history changes. How we use your Your credit score can affect whether you can get a loan and how much you will have to pay credit score for that loan. The range of Scores range from a low of to a high of scores Generally, the higher your score, the more likely you are to be offered better credit terms. How your score Your credit score ranks higher than percent of U.S. consumers). compares to- the scores of other consumers ICE Mortgage Technology, Inc. Page 1 of 3 G1CS3J 0418 G1 CS3J (POD) 10/31/2025 03:05 PM PST COUNTY N° 404315 E SANITARY PERMIT TRANSFER/RENEWAL PREVIOUS NO. ________ OWNER PLUMBER TOWN OF SEC.Jfe ,T!(N, R 0W AND/OR LOT G[K BL-96KCsen7.f&. SUBDIVISION CHAPTER t45i35 (2) WISCONSIN STATUTES (a) The purpose of the sanitary penaft is to afiow installerton of the private sewage system described In the permit. (b) The approval of the sanhtary penult is based on regulations In force on the date of approval. (c) Tire san!tary permit is vaf d and maybe renewed fore specified period. (d) Changed t regulations will not impair the vafldf'ty eta (a) Reirswal of the sanitary pencil w81 be based on regulations In force attho acne renewal is sought, and that drenged regulations may Impede renewal. (f) The santta y permit is hansferable. History: 1977 c.188;1979c.34,221; 1981 c.314 Note: If you wish to renew the pemdl, or transfer ownership of the permit, please contact the county authority. THORIZED ISSUING OFFICER - DATE4-.43 THIS PERMIT EXPIRES Dir-/b�D$' UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R.8/00) Docusign Envelope ID: A6685DC2-E7DF-4783-8883-E7B36741CFDE Loan #: 4256185002 Notice to the Home Loan Applicant In connection with your application for a home loan, the lender must disclose to you the score that a consumer reporting agency distributed to users and the lender used in connection with your home loan, and the key factors affecting your credit scores. The credit score is a computer generated summary calculated at the time of the request and based on information that a consumer reporting agency or lender has on file. The scores are based on data about your credit history and payment patterns. Credit scores are important because they are used to assist the lender in determining whether you will obtain a loan. They may also be used to determine what interest rate you may be offered on the mortgage. Credit scores can change over time, depending on your conduct, how your credit history and payment patterns change, and how credit scoring technologies change. Because the score is based on information in your credit history, it is very important that you review the credit -related information that is being furnished to make sure it is accurate. Credit records may vary from one company to another. If you have questions about your credit score or the credit information that is furnished to you, contact the consumer reporting agency at the address and telephone number provided with this notice, or contact the lender, if the .lender developed or generated the credit score. The consumer reporting agency plays no part in the decision to take any action on the loan application and is unable to provide you with specific reasons for the decision on a loan application. If you have questions concerning the terms of the loan, contact the lender. [ ] Experlan P.O. Box 2002 Allen, TX 75013 1-888-397-3742 www.experian.com [X] TransUnlon P.O. Box 1000 Chester, PA 19016 1-800-888-4213 www.transunion.com [ ] Equifax P.O. Box 740241 Atlanta, GA 30374 1-800-685-1111 www.equifax.com ICE Mortgage Technology. Inc. Page 3 of 3 Lu G1CS3J 0418 G1CS3J (POD) 10/31/2025 03:05 PM PST Land Use Permit Application Review Checklist Submission #: S`rlZ- Oo3oa, Tax ID: I(p S -T -R: —4'1-o° Town: What zoning district is the project located in? ❑R-1 R-2 El R-3 ❑R-4 ❑R-RB El 0 El ❑A-1 ❑A-2 ❑F-1 El F-2 0 ❑M -M ❑ Yes No Does lot meet the zoning dimensional requirements or is it substandard? Deed of record: ❑ Yes 1No Is the project located in the Shorelands (Shorelands are lands within 300feet of a river/stream OR landward side of floodplain OR 1000 feet of a lake/pond/flowage, whichever is greater)? ❑ Yes ''No Is the project located in the Floodplain? Zone: El Yes No Are there wetlands on the property? ❑ Yes No Is project associated with a nonconforming use or structure? Yesb No Does the project require sanitary? Sanitary Permit#: Public System: # of bedrooms: ❑ Yes XNo Does the project require an affidavit? ❑ LLC ❑ Trust Affidavit #: Number of Units: Number of Bedrooms: Number of Bathrooms: of o2 Number of Stories: 1 ❑ After -the -Fact (ATF) ATF Fee Amount: Inspected by: � � Date of Inspection: Inspection Notes: Re -Inspected by: Date of Re -Inspection: Denied by: Date of Denial: Reason for Denial: Date Denial Letter Mailed: Approved by: Date of Approval: Condition(s): )KTown/State/DNR/Federal may require permitting. ❑ This permit cannot be transferred if property is sold. ❑ A Bayfield County Health Dept permit is required. ❑ Check with Town regarding room tax. Short -Term Rental is fora maximum occupancy of persons. ❑ Additional conditions may be placed and need to be adhered to at the time of permit issuance. Other Conditions: 3-4-YFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: CULLITON, TODD R & LEA D STR-00321 3430 TWIN BAY RD BARNES, WI 54873 Transaction Number: STR-00321-38994 Description Amount 2 unit $1,000.00 Total: $1,000.00 Payment Amount: $1,000.00 Reference: 8010 Paid by: Lea and Todd Culliton Payment Type: Check Transaction Date: 11/26/2025 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 -X SANITARY - 404315 SPECIAL A — SPECIAL B/CONDITIONAL — BOA — No. 25-0860 Tax ID: 1996 Issued To: CULLITON, TODD R & LEA D BAYFIELD COUNTY hlfl11_ft■ WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION Location: S16 - T44N - R09W Town of Barnes Legal Description: LOT I CSM #1255 V7 P392 (LOCATED IN GOVT LOT 4) IN DOC 2024R-605803 Residential Structure in R-2 zoning district For: [2 -Unit] Short -Term -Rental (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): Town may require permitting. Short -Term Rental is for a maximum occupancy of 8 persons total/ 4 in each unit. NOTE: This permit expires two years from date of issuance if the authorized construction Desi Niewinski work or land use has not begun. Authorized Issuing Official 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. November 26, 2025 This permit may be void or revoked if any performance conditions are not Date completed or if any prohibitory conditions are violated.