HomeMy WebLinkAbout26-63SRj x'1 t- U°
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Industry Services Division
4822 Madison Yards Way
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SS - 00'766
R Madison, WI 53705
PS
1 5 2026
P.O. Box 7302
SanitaPermit Number (to be filled in by Co.)
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Madison, WI 53707
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planning and z Permit Application
Slate mnsaction Number
In accordance with 5P5383.21(2), Wis. Adm. Code, submission of this form to the appropriategovernmental unit
Project Address (if different than mailing address)
is required prior to obtaining a sanitary permit. Now: Application forms for state-owned POWTS arc submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
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purposes in accordance with the Privacy Law. s. 15.04(I)(m). Scats.
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OI/l S lUeY YI �Y'
I. Application Information Please Print All Information
—
Property Owner's Name
Parcel #
Dt bejeoviay4 l -1 -C
lak T1> Ij04$1
Property Oer's ailing Address
Property Location
Po 'R'k ('6
Govt. Lot
A '%. Section Z3
City, Slate 1-
4ohe- LJ (
Zip Code
Phone Number
K �-
SH'86'7
Sol- 646 -ze1z-
T 4'3 N R 07 E
H. Type of Building (check all that apply)
Lot #
®1 or 2 Family Dwelling— Number ofBedrooms
10
SV s _ Aid }p , u€. 2I+K V�
blic/Comntercial — Describe Use
L° c° V . 4o f P 9 z Co
Blockit f ENTERED
`
City of
State Owned — Describe Use
illage of
CSM Number
®Town of 04 a
M. Type of POWTS Permit; (Check either "New" or "Replacement" and other applicable on tine A. Check one box on line B. Complete line C i
a licable.)
A.
JNew System
I I--tReplacement System
Other Modification to Existing System (explain)
flAdditional Pretreatment Unit (explain)
B'
❑Holding Tank
aln•Ground
1.1.1 -Grade
DMound
Individual Site Design
Other Type (explain)
(conventional)
C.
Renewal Before
Revision
Change of Plumber
❑fmnsfer to New Owner
List Previous Permit Number and Date Issued
Expiration
a6- 635 (e are
IV.
Dispersal/Treatment
Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (sf)
I Dispersal Area Proposed (so
I System Elevation
300
• (
I W
53ZZA
R5.S
Capacity in
Total
# of
Manufacturer
°
Tank Information
Gallons
Gallons
Units
a
New Tanks
Existing Tanks
sSe
v
U
vI r
t,
lEa
a.
ry orflalding Tank
$kv b
gqv
les'e11'-
osi Chamber
5Op
C
V. Responsibility Statement— f, the undersigned
assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
(a
Plumbers Signature
MP/MPRS Number
'115tg58_5'905
Business Phone Number
D
1.5161z9i
Plumber's Ad ress (Street. City. State. Zip Code)
iO?6
VI. County/Department Use Only
roved
0 Disapproved Permit Fee
$
Date Issued
Issutn A Signature
m^
❑ Owner Given Reason for Denial ONS
_ aL
Conditions of Approval/Reasons for Disapproval
SBD-6398 (R. 02/22)
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-63RS
STATE SANITARY PERMIT
OWNER: DUFFY DEVELOPMENT LLC
GOV'T LOT: LOT: B LK:
1/4 1/4 SEC: 23, T 43 N, R 7 W
TOWNSHIP: Cable
SOIL TEST: 62-26
NEW SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: DYLAN SCHULTZ
SCOTT ROUSH DATE: 7/22/2026
Authorized Issuing Officer
CHAPTER 145.135(2) WISCONSIN STATUTES
a. The purpose of the sanitary permit is to allow installation of the
private sewage system described in the permit.
b. The approval of the sanitary permit Is based on regulations In force on
the date of approval.
c. The sanitary permit is valid and may be renewed for specified period.
d. Changed regulations will not impair the validity of a sanitary permit.
e. Renewal of the sanitary permit will be based on regulations in force at
the time renewal is sought, and that changed regulations may impede
renewal.
f. The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 C. 314
Note: If you wish to renew the permit, or transfer ownership of the
permit, please contact the county authority.
PREVIOUS PERMIT #: 26-63S
LICENSE: # MP 1516129
Condition: Properly Maintain System Per Recorded Agreement
THIS PERMIT EXPIRES 7/22/2028
ST IN PLAIN VIEIWAWI
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION
13-YFIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
DUFFY DEVELOPMENT LLC
PO BOX 145
STONE LAKE, WI 54867
Description
Sanitary Revisions
Submission Number:
SS -00766R
Transaction Number:
SS-00766R-4A6BF
Amount
$25.00
Total: $25.00
Payment Amount: $25.00
Reference: 1408
Paid by: JD Excavating LLC, 16880W Metcalf Rd, Stone Lake WI
Payment Type: Check
Transaction Date: 7/22/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.