HomeMy WebLinkAbout26-0057CS-ooIKS
RECEIVED
BAYFIELD COUNTY
SANITARY PERMIT APPLICATION
Zoning District
Lakes Class
N: APPLICATION IN
(Please Print All Infi
Property wn 's e
Address of Property:
V v(Ja, \y vwnc a w,ann,J ruu coq.'
J d�,� 72
ClrIat U), i� Code
VI
II. TYPE O BUILDING: (Check One)
❑ State Owned
2for
(Explain the use/purpose
2 or 2 Family Dwelling - No. of Bedrooms
Ill. TYPE OF PERMIT: (Check only one box on lin,
A) ❑ New ❑ Replacement
❑ Reconnection ❑ Repair
Soil Test//g z/ I County a/ �jos7
No: Permit No: t7
County: Bayfield
% /lam%,S 3f T S/ N,R v/ E
hio: I Gov. Lot#:
is
Tax ID#:
/Z/9'7
L: 'County Private Interceptor
❑ Revision ** ❑ Transfer of Owner (List Previous Owner below)
B) 9 A Sanitary Permit was previously issued. Previous Permit Number. aI b}S Date Issued: DI �7I a,o
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
2.
Absorp. Area
3. Absorp. Area I
4. Loading Rate
I 5. Perc. Rate
I 6. System I
7. Final Grade
Per Day
RQ((Sq.Ft.)
Jquired
PrCCoQjoosed (Sq. Ft.)
(Gals. / Day / Sq.Ft.)
(Min. Inch)
Elev.(Feet)
Elev. (Feet)
92
I
5C
VI. TANK
Capacity
I
I
I I
I
I
IFiber
INFORMATION:
In Gallons
Total
Gallons
# of
Tanks
Manufacturer's
Name
Prefab.
Concrete
Site
Constructed
Steel
-
glass
Plastic
Exper.
App.
New
Existing
Tanks
I Tanks
I
I
I I
I
Septic Tank or
I
/ t 2rSe/
Holdina Tank
I
I
VII. RESPONSIBILITY STATEMENT: I the undersigned, assume responsibility for installation of the onsite sewage sys3m shown on the tached plan .
Owner's Name(s): ( tint) Iflyin9 or SectionCabove OW r'S nature(s): o tamp
P1 mbis femme: Print) if applying for Section A or B) above Plumber ig e: (No Stamps) MP/lYfz W oNo:
JI L
Plumber's Address: Street, City State, Zip Code) o e Phone: Buu�sThess Phone:
VIII. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit/Transfer Fee: Date Issued: Issuing Agent's Signature / D e: /
���Approved ❑ Owner Given Initial
Adverse Determination I /e X1 _ l xii2 27/s'
IX. CONDITIONS OF APPROVAL I REASONS FOR DISAPPROVAL
4
nn rnvnran
Lot Line
4 Name of Frontage Road
1. Name the frontage road and use as a guideline, fill in the lot dimensions and indicate North (N).
2. Show the approximate location and size of the building. IMPORTANT
DETAILED PLOT PLAN
3. Show the location of the well, septic tank and drain field. IS NECESSARY, FOLLOW
_ STEPS 1-7 (a -o) COMPLETELY
4. Show the location of any lake, river, stream or pond if applicable.
5. Show the approximate location of other existing structures.
6. Show the approximate location of any wetlands or slopes over 20 percent.
7. Show dimensions in feet on the following:
a. Building to all lot lines i. Privy to building
b Building to centerline of road j. Privy to lake, river, stream or pond
c. Building to lake, river, stream or pond k. Drain field to closest lot line
d. Septic / holding tank to closest lot line I. Drain field to building
e. Septic/holding tank to building m. Drain field to well
f. Septic / holding tank to well n. Drain field to lake, river, stream or pond
g. Septic / holding tank to lake, river, stream or pond o. Well to building
h. Privy to closest lot line
Submit To: Bayfeld County Zoning Department, PO Box 58, Washburn, WI 54891
u/forms/sanitary/bayfieldcountysanitaryapplication
Revise: June 2018 Proofed by:
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RECEIVED
J,' -\.i1 217026
Bayfield co.
Planning and Zoning Agency
I
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B =YFIELD Bayfield County
Planning & Zoning Department
117 E 5w Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-4010
Property Owner: Submission Number:
CS -00145
Transaction Number
CS -00145-3E683
Description Amount
Private Interceptor $50.00
Payment Amount: $50.00
Reference: 1826
Paid by: A -Jackson Concrete LLC
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
SIGN -
SPECIAL -
CONDITIONAL -
BOA -
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
No. 26-0057 Tax ID# 12177 Issued To: JACKSON, CORY & JESSICA & JACKSON, ANDREW & KRISTIN
Location: NW'/a of NW'/a Section 35 Township 51 N. Range 07 W.
Town of CLOVER
Legal Description: LOT 15 CSM #1080 (LOCATED IN W 1/2 NW NW) IN DOC 2024R-603363
Residential Structure in RRB Zoning District
For: Sanitation Permit — Private Interceptor [Previous Permit # 24-122S]
(Disclaimer): Any future expansions or development would require additional permitting.
Condition(s): Cabin -A
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
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.
Tracy Pooler, AZA
Authorized Issuing Official
February 17, 2026
Date