HomeMy WebLinkAbout26-0421CS-oo1,10
BAYFIELD COUNTY ZoningDismct
SANITARY PERMIT APPLICATION Lakes Claea
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Permit No:
Property Owner's Name:
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County: �t JI Bayfield
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Addreess[of(Property:
Property Location:
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C
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Property Owner's Mailing Address:
To hip:
Gov. Lot #:
3904 N 2I' sf•
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2
ity, State Zip Cod Phone Number
WI S',$ o '
Lot #
Block #:
CSM #:
CSM Doc #
Subdivision Name
v ertor 7If"29Z
33
171
❑ State Owned
Tax ID#: RED
❑ Public (Explain the use/purpose )
p Lo g�6
1 or 2 Family Dwelling -No, of Bedrooms
A) ❑ New ❑ Replacement ❑ County Private Interceptor
7 Reconnection ❑ Repair ❑ Revision * ❑ Transfer of Owner (List Previous Owner below)
B) ® A Sanitary Permit was previously issued. Previous Permit Number 'yy/� Zate Issued: f/— / Yr 13
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C) ❑ Pit Privy ❑ Vault Privy (Vault size: _gallons or _cubic yards)
❑ Portable Privy ❑ Camping Transfer Unit Container ❑ Composting Toilets ❑ Incinerating Toilet
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sorp. Area
3. Absorp. Area
4. Loading Rate
5. Pere. Rate 6. System
7. Final Grade
Proposed (Sq. Ft.)
(Gals. / Day / Sq.Ft.)
(Min. Inch) Elev.(Ft.
Elev. (Feet)
4Per;Required,(Sq.Ft.)
?e'3
&sO
9Y• 3
Capacity
In Gallons
Total
# of
Manufacturer's
Prefab.
Site
Steel
Fiber
-
Plastic
Exper.
New Existing
Gallons
Tanks
Name
Concrete
Constructed
glass
App.
Tanks Tanks
Septic Tank or
/000
F.
/40w
�gs/yt/fs[
X
Holding Tank
Lift Pump Tank I
Siphon Chamber
I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Owner's Name(s): (Print) If applying forSection C above
Owner's Signature(s): (No Stamps)
Plumber's Name: (Print) If applying for Section A or B) above
Q
mb Cs Signature: (No Stamps)
MP/MPRSW No:
aV\ A eIlao
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Plumber's Address: t City S��Bt�( Zi Code) HometlPhon : G d2 Business P o e: �/
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❑ Disapproved Sanitary Permit/Transfer Fee: Date Issued: Issuing nt's Signature / ate:
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Owner Given Initial S./h 3/�6
"proved❑
Adverse Determination
AUG 112026
Bayfield Co. Plot Plan on reverse side
Planning and Zoning Agency
C
Lot Line
1.
2.
3.
4.
5.
6.
7.
Name of Frontage Road ( )
Name the frontage road and use as a guideline, fill in the lot dimensions and indicate North (N).
Show the approximate location and size of the building.
IMPORTANT
DETAILED PLOT PLAN
Show the location of the well, septic tank and drain field.
IS NECESSARY, FOLLOW
STEPS 1.7 (a -o) COMPLETELY
Show the location of any lake, river, stream or pond if applicable.
Show the approximate location of other existing structures.
Show the approximate location of any wetlands or slopes over 20
percent
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
RECEIVED
u/fonns/sanitary/bayfieldcountysanitaryapplication
Revise: June 2018
AUG 11 2026
eayfield Cn. Proofed by:
Planning and Zo ,: ; Ager:
P 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 -00180
Transaction Number.
CS-00180-4BE8F
Description Amount
Private Sewage System Reconnection $50.00
Total: $50.00
Payment Amount: $51.95
Reference: 1285340135
Paid by: Neil O' Shaughnessy Jr
Payment Type: Credit Card
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
: 1 iIf
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
No. 26-0421 Tax ID: 39607
Issued To: O'SHAUGHNESSY, NEAL B JR
Location: S18 - T44N - R09W
Town of BARNES
Legal Description: LOT 1 CSM 2404 IN DOC 2025R-607730 BEING IN GOV LOT 2 691C IN DOC 2026R-611060
Residential Structure in R-1 Zoning District
For: Sanitation Permit — Reconnection [Previous Permit # 13-134S (11/14/2013)]
(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.
Tracy Pooler, AZA
Authorized Issuing Official
August 13, 2026
Date