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Home My WebLink About26-0126BAYFIELD COUNTY I Zoning District CS-oo iSa- SANITARY PERMIT APPLICATION Lakes Class I. APPLICATION INFORMATION Soil Test — / O County {, 'v 6it (Please Print All Information) No: PermNo: V Property Owner's Name: ,cobe County: Bayfleld a A ress of Property: Property Location: oa6 vrK k' Ae.'bsk-e1r % A,S T N,R E (or)W Property Owner's Mailing Address: Township: I Gov. Lot #: (ot3O W. Icon a Lr City, State I Zip Code I Phone Number Lot # I Block #: I CSM #: I CSM Doc # I Subdivision Name 'r -or fR�ver W\. 5Cig3q-1 h153nm2400 II. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: C VED ❑ Public (Explain the use/purpose ) /� a 3qJ J 7/' �r� 1 or 2 Family Dwelling - No. of Bedrooms APR 202026 Ill. TYPE OF PERMIT: (Check only one box on A. Check box on line B, if applicable) A) ❑ New ❑ Replacement ❑ County Private Interceptor ayi1eId Co. Planning and Zoning Agency ® Reconnection ❑ Repair ❑ Revision *` ❑ Transfer of Owner (List Previous Owner below) mou L.15 B) ❑ A Sanitary Permit was previously issued. Previous Permit Number J) als Date Issued: 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 4. Loading Rate 5. Perc. Rate 6. System 7. Final Grade Per Day Required (Sq.Ft.) Proposed (Sq. Ft.) (Gals. / Day / Sq.Ft.) (Min. Inch) Elev.(Feet) Elev. (Feet) Fiber INFORMATION: In Gallons Total #of Manufacturer's Prefab. Site Exper. New Existing Gallons Tanks Name Concrete Constructed Steel - Plastic App. Tanks Tanks glass Septic Tank or Zoa e Holdin Tank Lift Pump Tank / Siphon Chamber I the undersigned, assume responsibility for installation of the onsite Owner's Name(s): (Print) pifapp1lying for Section C above John Oc0t Plumber's Name: (Print) If applying for ecuon A ore) above Plumbe 'ok l3roLrver i Plumber's Address: (Street, City State, Zip Code) 3 50 tvThC S t/�II1i° VIII. COUNTY! DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit/1 Approved ❑ Owner Given Initial Adverse Determination on lome Phone: — Business Phor -h'klyrzci:» In5,^lale as ceytIP o1 . /o - &1tt(y On (,/Ac)cnG, Plot Plan on reverse side 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 a. 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/bayfieldcountysanitarya pplication Revise: June 2018 Proofed by: B =YFIELD 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 Sewage System Reconnection Submission Number: CS -00152 Transaction Number. CS -00152-447E4 Amount $50.00 Total: $50.00 Payment Amount: $51.95 Reference: 8557920895 Paid by: John Broberg Payment Type: Credit Card 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 - Reconnect (10-23S) SIGN - SPECIAL - CON DITIONAL - BOA - BAYFIELD COUNTY fl 1, WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 26-0126 Tax ID# 12395 Issued To: BROBERG, JOHN M & MARGARETTE A Location: Section 27 Township 51 Range 07 Town of CLOVER Legal Description: GITCHE GUMEE SHORES LOT 1 CSM #1880 IN V.11 P.118 (LOCATED IN LOTS 12 - 14) IN DOC 2019R-577833 Residential Structure in RRB Zoning District For: Sanitation Permit — Reconnect (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): Insulate as required. 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. Emily Macgillivray, AZA Authorized Issuing Official April 28, 2026 Date This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated.