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Home My WebLink About26-0254BAYFIELD COUNTY GS- O0) bo SANITARY PERMIT APPLICATION Zoning District Lakes Class I. APPLICATION INFORMATION Soil Test I County & o as (Please Print All Information) No: Permit No: J l Property Owner's Name: County: Bayfleld Grant & Brigette Bludorn Address of Property: Property Location: x 61280 Kelly Rd. Mason NW 1/4 SW ¼,S 14 T 46 N, R 5 E (or) W Property Owner's Mailing Address: Township: I Gov. Lot #: 63534 Marengo River Rd. Kelly City. State I Zip Code I Phone Number Lot # I Block #: I CSM #: CSM Doc # I Subdivision Name Marengo, WI 54855 605-520-0192 I I I -- II. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: ❑ Public (Explain the use/purpose ) ee 21130 !'%i j 282025 x 1 or 2 Famil Dwellin - No. of Bedrooms 1 III. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) ❑ New ❑ Replacement ❑ County Private Interceptor Planninj c:nd _'cutr1p.4cenc/ Q Reconnection ❑ Repair ❑ Revision *` ❑ Transfer of Owner (List Previous Owner below) B) Q A Sanitary Permit was previously issued. Previous Permit Number 19-0290 Date Issued: 11/21/90 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 Required (Sq.Ft.) Proposed (Sq. Ft.) (Gals. / Day / Sq.Ft.) (Min. Inch) Elev.(Feet) Elev. (Feet) VI. TANK Capacity Fiber INFORMATION: In Gallons Total Gallons #of Tanks Manufacturers Name Prefab. Concrete Site Constructed Steel - glass Plastic Exper. App. New Existing I Tanks Tanks Septic Tank or Holding Tank x 2000 2 Rassmussen x 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 applying for section c above Owner's Signature(s): (No Stamps) Plumber's Name: (Print) it applying for Section A or a) above I Plumber's Signa r (No Stamps MP/MPRSW No: Edward B. Redinger 221939 Plumber's Address: (Street, City State, Zip Code) Home Phone: Business Phone: 1015 11th Ave. E. Ashland, WI 54806 715-413-0122 7l5-2926670 VIII. COUNTY! DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit/Transfer Fee: Date Issued: Issui ent's Signature / Date: ��,,��.(((``` Approved ❑ Owner Given Initial / Adverse Determination IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Plot Plan on reverse side RECEIVED MAY 282026 Lot Line Planning and Zoning Ayy4 -c ti o- a 8 �I41-rl v ti Jr U U- . weet 5Q. 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 ulforms/sanitary/bayfieldcountysanitaryapplication 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: Submission Number. CS -00160 Transaction Number: CS-00160-46AAE Description Amount Private Sewage System Reconnection $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 10757 Paid by: Superior Plumbing & Mech Inc 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 - Reconnection SIGN - SPECIAL - CONDITIONAL - BOA - BAYFIELD COUNTY WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 26-0254 Tax ID: 21130 Issued To: BLUDORN, GRANT S & BRIGETTE N Location: S14 - T46N - R05W Town of KELLY Legal Description: SW NW SW IN DOC 2025R-607861 Residential Structure in AG -1 Zoning District For: Sanitation Permit — Reconnection [Previous Permit # 149779/19-0290 (11/21/1990)] (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): 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. Scott Roush, AZA Authorized Issuing Official June 16, 2026 Date