HomeMy WebLinkAbout26-0058Zoning District
Lakes Class
RECEIVED GS-ool'ib
BAYFIELD COUNTY
SANITARY PERMIT APPLICATION
JAN 21 2016
I. 'APPLICATION INFORMATION
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No:
Permit No:
Prope y Owner'sJ: e-�'—
County: Bayfield
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Address f Proppeert' 2_ �/
P�rloperty Location:
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�U� % S S T Y( N. R 07 E @r)
Property Ownel's�vt�ng Addres
Township:
I Gov. Lot #:
.��2Z2.11,ty viSp c
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City, S � /
Zip Code
2/
Phone Number
Lot #
Block #:
CSM #:
CSM Doc It
Subdivision Name
/
/
f yI
II. TYPE OF BUfLDING: (Check One)
I
❑ State Owned
Tax ID#:
❑ Public (Explain the use/purpose )
/7//7/7
� or 2 Family Dwelling - No. of Bedrooms .7 -
.111. TYPE OF PERMIT: (Check only one box on line A. Checkkox on line B, if applicable)
A) ❑ New ❑ Replacement County Private Interceptor
❑7f; Reconnection ❑ Repair ❑ Revision ** ❑ Transfer of Owner (List Previous Owner below)
B) _ " A Sanitary Permit was previously issued. Previous Permit Number.{- iJ'JS Date Issued: 'b /?7/?oaL
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
3. Absorp. Area
4. Loading Rate
I 5. Perc. Rate
I 6. System I
7. Final Grade
Per Day
R cyuired (SJc Ft.)
�_
Prop9ed Sq. Ft.)
(Gals. / Day/ Sq.Ft.)
(Min. Inch)
Elev.(Feet)
Elev. (Feet)
ck)
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e 7
I
I 5ti/ z
Ih s
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
2V
/
1 1 _ib9
kJ�
Holding Tank
Lift Pump Tank /
Siphon Chamber
-
VII. RESPONSIBILITY STATEMENT:
I the undersigned, assume responsibility for installation of the onsite sewage syst shown on the attached pla s.
Owne' Name(s): tint) if applyingfoorSSection above
Ow s gnature(s), ( Stam
Plu er' e:(Thin!) if applying for Section A or B) above
Plumber u : (No Stamps
MP/MPRSW No:
Plum is Address: (Street, City State, Zip Code)
2/ Sf 1 Js€22
o e Phone:
Sic mss/ 9X
Business Phone:
2is = - z�
VIII. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved
I Sanitary Permit/Transfer Fee:
Date Issued:
issuing gent's Signature /Date:
Approved
❑ Owner Given Initial
Adverse Determination
IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
Plot Plan on reverse side
Lot Line
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 (ao) 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: Bayfield County Zoning Department, PO Box 58. Washburn, WI 54891
u/forms/sanitary/bayfieldcountysan itaryapplication
Revise: June 2018 Proofed by:
4.
1
RECEIVED
JAN 2 .� 2026
Bayield Co.
Planning and Zoning Agency
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B'TFIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-4010
Property Owner:
Description
Private Interceptor
Submission Number:
CS -00146
Transaction Number.
CS -00146-3E685
Amount
$50.00
Total: $50.00
Payment Amount: $100.00
Reference: 1826
Paid by: A -Jackson Concrete LLC
Payment Type: Check ( s $ ( p �U .
h l v v" p
Gf—L WPn �or N ISv, only needcv loo.
tic to Gov&( i n+&r(eP4- )Ca'
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. 26-0058 Tax ID# 12177 Issued To: JACKSON, CORY & JESSICA & JACKSON, ANDREW & KRISTIN
Location: NW '/4 of NW'/4 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 - B
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