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HomeMy WebLinkAbout26-0149BAYFIELD COUNTY GS_ 00 I S1 SANITARY PERMIT APPLICATION Zoning District Lakes Class I. APPLICATION INFORMATION (Please Print All Information) Soil Test County No: /."J —� a' Permit I. O 1 No: �-ll _I Property Owner's Name: ! pil!' 1 °L M 4/ K O C. A /, y County: Bayfield Address of Property: rt Property Location: ..r5 7/Q G ee i @ Lake /9j. % 4S /9' T 45 N. R % E (or)® Property Owner's Mailin Address: Township: Gov. Lot #: /5'lg/ /30-{l 5frae - (arms CityState ZS Code PhonNumber Lot# Block it: CSM#: C�SVM�1Doc # Subdivision Qf 6 / NA WA Iy ry /Name II. TYPE OF BU ING: (CheckOne ❑ State Owned Tax ID#: ❑ Public (Explain the use/purpose ) / > X 1 or 2 Famil Dwellin of Bedrooms .3 III. TYPE OF PERMIT: (Check only one box on A. Check box on line Br if applicable}. A) ❑ New ❑ Replacement ® County Private Interceptor ❑ Reconnection ❑ Repair ❑ Revision " ❑ Transfer of Owner (List Previous Owner below) B) ❑ A Sanitary Permit was previously issued. Previous Permit Numbert; 0 -) ' t7atr(e Issued: 9//r/ o, z IV. TYPE OF NON -PLUMBING SYSTEM: (Check. One) ' Replacements needprevious 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 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.FL) (Min. Inch) Elev.(Feet) Elev. (Feet) "So Gy_.8c 6S'-- 7-4-,004i: 48 oo4f, VI. TANK INFORMATION: Capacity In Gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Constructed Steel Fiber gl Plastic Exper. App New Existing Tanks Tanks Septic Tank or t1 �� �fd Holdin Tank Lift Pump Tank / Siphon Chamber VII. RESPONSIBILITY STATEMENT: I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Owner's Name(s): (Print) If applyingforSection c above Owner's Signature(s): (No Stamps) Plumber's Name: (Print If applying fat Section Aor a)above Plumber's Si nature: (No Stamps) MP/MPRSW No: -if� url'fi Ai4- gc3> Plumber's Address: (Street, Ci%ttite, Zi Code) Home Phone: Business Phone: Id J2- t 7&t 're:, pfoo,ntil- w,: svr 7/Y-3'7-- ?S3 7(.s- srs - VIII. COUNTY I DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit/TransferFees Date Issued: Issuing Acw nfss Signature / Date: 1 Approved ❑ Owner Given Initial S 6 ab Adverse Determination (/�� y7)% IX, CONDITIONS OF APPROVAL! REASONS FOR DISAPPROVALgo- c6AA� / i Gr_ RECEIVED APR 232026 Plot Plan on reverse side ld lanning an nnd Zoning n pg Agency Lot Line /Q7( 1060 cmllon I '(oak raft Fcl© /y' 1 Is' Li+�e G Q. ✓+� � 1 \ Goor , Lakt Pt. Name o 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 b Building to centerline of road c. Building to lake, river, stream or pond d. Septic / holding tank to closest lot line e. Septic/holding tank to building f. Septic / holding tank to well g. Septic / holding tank to lake, river, stream or pond h. Privy to closest lot line i. Privy to building j. Privy to lake, river, stream or pond k. Drain field to closest lot line I. Drain field to building m. Drain field to well n. Drain field to lake, river, stream or pond o. Well to building Submit To: Bayfield County Zoning Department, 1 PO Box 58, Washburn, WI 54891 u/forms/sanitary/bayfieldcountysanitaryapplication r t,`ECEWED Revise: June 2018 APR 232026 Bayfield Co. Planning and Zoning AgencY Proofed by: HAYFIELD 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: Submission Number: CS -00154 Transaction Number. CS-00154-44DA5 Description Amount Private Interceptor $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 2108 Paid by: Laurie Koehler 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 — No. 26-0149 Tax ID: 4022 Issued To: KOEHLER, LAURIE M Location: S18 - T45N - R09W Town of BARNES BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION Legal Description: REDFOXS ADD TO POTAWATOMI LOT 61 IN DOC 2019R-576641 2217 Residential Structure [RV] in R-1 Zoning District For: Sanitation Permit —Private Interceptor [Previous Permit # 22-120S (9/19/2022)] (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): RV CONNECTION 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) 585-2900. 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 May 6, 2026 Date