HomeMy WebLinkAbout26-0145BAYFIELD COUNTY zoning DiaWd
cc- 00 t SANITARY PERMIT APPLICATION I
takes class
1. APPLICATION. INFORMATION
Soil Test County
(Please Print All Information) -
No: Permit
No: - 01��
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Property Owners Name:
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C
County: Bayfleld
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Address of Property:
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77O1 &V 5 %Jrt/rr Lc/<'c A,?
Property Location:
% %,S /9 T `/7 N,R E(or)9
Property Owner's Mailing Address:
Township:
I Gov. Lot #:
S
kfr≤ 41 j1er `l4S
C State ,i
Zip Code
I Phone Number
Lot # I
Block #.
CSM #:
CSMDoc# #
Subdivision Name
11. TYPE OF BUILDIN: (Check One)
❑ State Owned
Tax ID#: A r -7l
❑ Public (Explain the use/purpose
I or 2 Family Dwelling - No. of Bedrooms
0 Y O Lj. a. -97 - 0g -/q jv -OU -/9086
111. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) ❑ New ❑ Replacement ❑ County Private Interceptor
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❑ Repair ❑ Revision " ❑ Transfer of Owner (List Prev1i OUn tZJ1? v)
Reconnection
BayfleCo.
PlanninE and nin gency
B) A Sanitary Permit was previously issued. Previous Permit Number. /) 2-% g /I Date Issued: e07
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
I 3. Absorp. Area
I 4. Loading Rate
I 5. Perc. Rate
I 6. System I
7. Final Grade
Per Day
I Regyi ed (Sq.Ft.)
I Proposed (Sq. Ft.)
(Gals. / Day / Sq.Ft.)
(Min. Inch)
Elev.(Fee)
Elev. (Feet)
o
2i7
0-7o
,-7
-
_
VI. TANK
INFORMATION:
Capacity
In Gallons
Total
Gallons
# of
Tanks
Manufacturer's
Name
Prefab.
Concrete
Site
Constructed
Steel
Fiber
glass
Plastic
Exper.
App.
New
Existing
Tanks
Tanks
Septic Tank or
Holdin Tank
ic2-f D
111 D
I
!!"�'�
0 t er
Lift Pump Tank I
-1
S
7S
i
L
Siphon Chamber
1
Ed
VII. RESPONSIBILITY STATEMENT:
I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Owner'sName(s):4Print) Itapiel)4ng for Section C above
Owner'sSignature(s): (No Stamps)
Plumber's Name: (Print) n'//Ifapp/ly'u�gfor Section Aore)above
Plumber's ig oSta//plps)
MP/MPRSWNo:
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Plumber's Address: (Street, CityS9 fe, Zip Code)
S2-2—., vc (?--i✓2vW351/8
Home Phone:
7 7/Sz92-K(5 /a
Business Phone:
71SzSz- t'/S ,
VIII. COUNTY I DEPARTMENT USE ONLY
❑ Disapproved
Sanitary Permit/Transfer Fee:
Date Issued:
I Iss`ying Agen s Signature / Date:
�
Approved
❑ Owner Given Initial
S.
CC✓41 �`1/V"Ct_
Adverse Determination
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IX. CONDITIONS OF APPROVAL f REASq S'FOR DISAPPROVAL:
Plot Plan on reverse side
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MAY 01 2026
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B--1Y� FIELD 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 -00155
Transaction Number.
CS -00155-45188
Amount
$50.00
Total: $50.00
Payment Amount: $51.95
Reference: 6534487055
Paid by: Mary Patnode
Payment Type: Debit
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 - Reconnection
SIGN -
SPECIAL -
CONDITIONAL -
BOA -
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
No. 26-0145 Tax ID: 19499
Issued To: PATNODE, EUGENE R
Location: S19 - T47N - R08W
Town of IRON RIVER
Legal Description: W 112 OF PAR #4 & PAR #5 IN GOVT LOT 1 IN V.822 P.498 417R
Residential Structure in R-1 Zoning District
For: Sanitation Permit — Reconnection [Previous Permit # 07-184S (10/02/2007)]
(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) 6852900.
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.
Emily Macgillivray, AZA
Authorized Issuing Official
May 5, 2026
Date