Loading...
HomeMy WebLinkAbout26-0425CS-oo)?9 BAYFIELD COUNTY SANITARY PERMIT APPLICATION Zoning District Lakes Class Ir APPLICATION INFORMATION Soil Test County .-.;(Please.PrintAt!Information) No: Permit No: Property Owner's Name: e / County: f L/ Bayfleld / awl f4 -t .mss Address of Property: /9 sf shta✓I Rd Property Location: '. %.S /g T YY N.R 7 E (or) Property Owner's Mailing Address: T hip: Gov. Lot #: 2 3901, N Zl11 if. 4r4fl Zip Code PhoneNumber Lot # Block #: CSM #: CSM Doc # Subdivision Name pgity,tate �rtW1'y1S2 Tax ID#: ENTERED ' OF BUILDING o (Check, One) ❑ State Owned ❑ Public (Explain the use/purpose ) 3a _© 1 or 2 Family Dwelling - No. of Bedrooms HI iTVPE oP PERMIT' (Check onl _one box on line A_ Ch ck box on' tine g if ap Iicable _--.__.__ A) ❑ New ❑ Replacement County Private Interceptor i'Reconnection ❑ Repair ❑ Revision ❑ Transfer of Owner (List Previous Owner below) % -bale Issued'. if a yt �3 B) ® A Sanitary Permit was previously issued. Previous Permit Number. __ iv. Typ :ORN6 ":P ; "' fN is' S' ;(Check One)''' Replacements need previouspermit numberand 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_ABS9C P_ TlON SYSTEM IN . AT)ON. �� 1. Gallons 1 2. Absorp Area 3. Absorp. Area 4. Loading Rate 5 Perc. Rate 6. System 7. Final Grade e Elev. (Feet) Per Day Required.(Sq.Ft.) Proposed (Sq. Ft.) (Gals. / Day / Sq-Ft.) (Min. Inch) q .(FtL VI. TANK ,' n '° Capacity Fiber )N€ORMATION. In Gallons Total # of Manufacturer's Prefab. Site Steel - Plastic Exper. New Existing Gallons Tanks Name Concrete Constructed glass App. Tanks Tanks Septic Tank or �0D6 /060 �gjMwS� Holding Tank Lift Pump Tank! Siphon Chamber I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Owner's Name(s): (Print) ifapplying for section C above Owners Signature(s): (No Stamps) Pllumbers Name: Napplying for Section A or B) above b is Signature: (No Stamps) MP/M RSINN : �(tPri)nt) 2.IL/t 15°N� �� r �/2 Business Phone• Plumber's Address: 1StfeSt City S te Zi r & di rl I S nos 9 Q — $�j 0 % Zip / U 1(e E" CC S-!-t�3-- NTY!DEPA#TmE TUSEONLY: ,. Vfit, COi/N, � � ❑ Disapproved Sanitary PermitTransfei Fee: Date Issued Issuing A ent's Signature / Date: ❑ Owner Given Initial �I �KI �J 6 / /�j,/3 A ed Adverse Determination )(,. CONDITIONS OF APPROVAL! REASONS FOR DISAPPROVAL: AUG 112026 Planr>R� i€2V.. :kaeri vide Lot Line ivauue a' rroruage Koao ( ) 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 3. Show the location of the well, septic tank and drain field. DETAILED PLOT PLAN IS NECESSARY, FOLLOW 4. Show the location of any lake, river, stream or pond if applicable. STEPS 1-7 (a -o) COMPLETELY 5. Show the approximate location of other existing structures. RECEIVED 6. Show the approximate location of any wetlands or slopes over 20 percent. AUG 1 12026 7. Show dimensions in feet on the following: Sayfield co. Planning and Zoning Agency a. Building to all lot lines I. Privy to building b Building to centerline of road j. c. Building to lake, river, stream or pond k. Privy to lake, river, stream or pond 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. g. Septic / holding tank to lake, river, stream or pond o. Drain field to lake, river, stream or pond Well to building h. Privy to closest lot line Submit To: Bayfleld County Zoning Department, PO Box 58, Washburn, WI 54891 u/forms/sanitary/bayfieldcountysanitaryapplication Revise: June 2018 Proofed by: 3AYFIELD Bayfield County Planning & Zoning Department 117E 5w Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-4010 Property Owner: Submission Number: CS -00179 Transaction Number: CS -00179-4C065 Description Amount Private Interceptor $50.00 Total: $50.00 Payment Amount: $51.95 Reference: 3295773145 Paid by: Sandra O' Shaughnessy 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 - Private Interceptor SIGN - SPECIAL - CONDITIONAL - BOA - No. 26-0425 Tax ID: 39607 Issued To: O'SHAUGHNESSY, NEAL B JR Location: S18 - T44N - R09W Town of BARNES BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION 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 — Private Interceptor [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 14, 2026 Date