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Home My WebLink About26-0385BAYFIELDCOUNTY CS_oo)S& SANITARY PERMIT APPLICATION Zoning District Lakes Class 1. -APPLICATION INFORMATION Soil Test County 6 _ (Please Print All Information) No: Permit No: Cl Property Owner's Name: Brittny Cloutier County: Bayfield Address of Property: Property Location: 22180 STATE HWY 13 S34-T51N-RO6W Property Owner's Mailing Address: Township: Gov. Lot #: 899 200th Ave City, State Zip Code Phone Number Lot# Block#: CSM #: CSM Doc# Subdivision Name Luck, WI 54853 7155542562 II. TYPE OF BUILDING: (Check One) Tax ID#: 7975 ;111; TYP.E0F:P.ERMIT: (Check only one box on line A. Check box on line B, if applicable)., a A) New MAY 232026 B) Was a Sanitary Permit Previously Issued: false Bayfield Co. Planning and Zoning Agency IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) * Replacements need previous permit number and date filled out above C) Camping Unit Transfer Container V. ABSORPTION SYSTEM INFORMATION: 1. Gallon 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. 6. System 6. Final Grade s Per Required Proposed (Sq. (Gals. / Day / Rate Elev.(Feet) Elev. (Feet) Day (Sq.Ft.) Ft.) Sq.Ft.) (Min. undefined Inch) VI. TANK Capacity Fiber INFORMATION: In Gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete site Constructed Steel - glass Plastic Ecper. APp New Existing Tanks Tanks SepticTankor 300 300 1 x Holding 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 applying for Section C above Owner's Signature(s): (No Stamps) Plumber's Name: (Print) If applying for Section A or a) above Plumber's Signature: (No Stamps) MP/MPRSW No: Plumber's Address: (Street, City State, Zip Code) Home Phone: Business Phone: VIII. C NTY I DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit/Transfer Fee: Date Issued: Issuing Agent's ignatY`fe / Date: Approved ❑ Owner Given Initial Sa•b gm) ((/)Ilt Adverse Determination �f IX. CONDIT,.1O S.OFAPPROVAL (:REASONS FOR DISAPPROVAL: Qln-kcM as fefred by -fk, £+aie Seru�q a1 bas -4 Ono Q 9O/ - Plot Plan on reverse side Lot Line RECER'ED MAY 2 3 2026 Bayfield Co. Planning and Zoning Agency 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: Bayfield County Zoning Department, PO Box 58, Washburn, WI 54891 u/forms/sanitary/bayfieldcou ntysanitaryapplication Revise: June 2018 Proofed by: N e0.Gk 0, gale, = 5'y. S' RECEIVED MAY 232026 Bayfiied co. Planning a. ti Zoning Agency peck - ' jt' Ifl/ Dr Shea C (e c s-hy) 95' py-s- 5 • Elu�ric V IN cS,001Ss CAMPING UNIT TRANSFER CONTAINER (CUTC) SERVICING CONTRACT Contract Date: /ao lo?e This contract is made between: Brittny & Greg Cloutier rM of a Camping Pumper's (Service Provider) Name: Birch Street Excavating & Septic Service Inc on the PROJECT Legal Description: (Use Tax Tax ID# 7 975 LOCATION Statement) NW 9W 34 51 6 Town of: I Lot Size I Acreage 114, 114, of Section ,Township N, Ranga W I Bell 150X200 .69 Gov't Lot J Lot # CSM # I Vol. Page I CSM Doc # I Lot(s) No. I Block(s) No. Subdivision: A 1. The owner agrees to file a copy of this contract with Bayfield County Planning and Zoning Agency as required in Title 15 of the Bayfield County Sanitary Ordinance. 2. The owner agrees to have the CUTC serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the CUTC. The owner agrees to maintain the access road or drive so that the pumper can service the CUTC with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred In servicing the CUTC as mutually agreed upon by the owner and pumper. 3. The pumper whom has signed the pumping agreement agrees to submit to the local government unit (Bayfield County Planning and Zoning Agency) a report for the servicing of the CUTC on an annual basis as required by Title 15 of the Bayfield County Sanitary Ordinance. The pumper further agrees to include the following in the annual report: a. The name and address of the person responsible for servicing the CUTC; b. The name of the owner of the CUTC; c. The location of the property on which the CUTC is installed; d. The dates on which the CUTC was serviced; e. The volumes in gallons of the contents pumped from the CUTC for each servicing; f. The disposal sites to which the contents from the CUTC were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract and/or a copy of a new service contract with the local government unit (Bayfield County Planning and Zoning) named above within (10) business days from the date of change to this service contract. Greg & Brittn Owner(s) Signature: This Instrument was signed before me in the Stets of Wisconsin, tier County ofBayfieM PIplk On this My commission expires on: RECEIVED JUL 302026 Bayfieid Co. Created: April 17, 2012 (Bayfleld County Zoning) —®May2026 Planning and Zoning Agency Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (I)(m)) Y s s1 it • .i:' _— .. �_ 1 :• .. -. l r,_ S r _ -._ -_... _ .. _ '' _ ._- —._ _ _ .�'. '.. 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J!,i :j{il •• ..a !1 ) � .ii:t itt _ r :l:' . ._.. Z.t_ f . I ll. i.a •. i i t •:'_,, , i^••`•'.i,, to 'I. - -- .. _ _ _ _ - _ _. - — ___ __. _. _ .. - -. ,h`•• tt L,�rF --+ i Iilftt I+f.. 2 .s. •.7 B^YFIELD Bayfield County Planning & Zoning Department 117E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-4010 Property Owner: Description County Sanitary Permit: I Submission Number. CS -00158 Transaction Number: CS-00158-466FD Amount $150.00 Total: $150.00 Payment Amount: $151.25 Reference: 5888825355 Paid by: Brittny Cloutier Payment Type: Other 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 — Camping Unit Transfer Conta SIGN - SPECIAL - CONDITIONAL - No. 26-0385 Tax ID: 7975 Issued To: CLOUTIER, GREGORY L & BRITTNY L Location: S34 - T51 N - R06W Town of BELL BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION Legal Description: LOT A OF CSM V.2 P.68 BEING A PAR IN NW SW IN V.898 P.597 508A IM 2004R-493476 IN DOC 2025R- 610030 Residential Structure in R-1 Zoning District For: Sanitation Permit — Camping Unit Transfer Container [300 Gallon] (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): Maintain as required by the state. Service at least once per year. 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) 665-2900. 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. Emily Macgillivray, AZA Authorized Issuing Official August 5, 2026 Date