HomeMy WebLinkAbout26-0501CS oojQO BAYFIELD COUNTY
SANITARY PERMIt APPLICATION
Zoning District
Lakes Class
• 1. APPLICATION INFORMATION
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(Please Print All Information)
No.
Permit No: D S
Property Owner's Name:
Ft,c• t cjc v vc Fq6: c , 'Jr.
County: Bayfield
Address of Property:
Property Location:
�/
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1/70 Gv w7 I: , rc (r_,,I,../ 5-v52v
NW'/< YU/ Y.S 3! T ti7 N,R . (or®
Property Owner's Mailing Address:
Township:
Gov. Lot #:
/5'03Z_ &vergree,, L,,. Qr4/e w/ SP'rSZ O
Ori er,-rCt.
City, State /��
Zip Code
Phone Number
Lot #
Block It:
CSM #:
CSM Doc #
Subdivision Name
'V/ Q.%t, w,'
6t C'
-7,' Gq 7 oas3
-,, e
IL TYPE OF BUILDING (Check One)
State Owned
❑ Public (Explain the use/purpose )
LLI
Tax ID#: Ii,E r13EC "
62 / i17/yb
I or 2 Family Dwelling - No. of Bedrooms
/ SEP 1 6 2026
Ill: TYPE OF PERMIT: Check only one box on line A. Check box online B, if a licable
A) ❑ New ❑ Replacement ❑ County Private Interceptor Planning and ZoningAgency
❑ Reconnection ❑ Repair Revision '* ❑ Transfer of Owner (List Previous Owner below)
B) ❑ A Sanitary Permit /0 cc F/3 6G
was previously issued. Previous Permit Numb/S"r.26 Date Issued: /
IV. TYPE OF:NON-PLUMBING SYSTEM: (Check One) * Replacements need previous permit number and date filled out above
000.
C) . ❑ Pit Privy Vault Privy (Vault size: a gallons or cubic yards)
❑ Portable Privy ❑ Camping Transfer Unit Container ❑ Composting Toilets ❑ Incinerating Toilet
V. ABSORPTION
SYSTEM INFORMATION:
1. Gallons
2. Absorp. Area
3. Absorp. Area
4. Loading Rate
5. Perc. Rate
6. System
7. Final Grade
Per Day
Required (Sq.Ft.)
Proposed (Sq. Ft.)
(Gals. / Day / Sq.Ft.)
(Min. Inch)
Elev.(Feet)
Elev. (Feet)
VI. TANK
Capacity
INFORMATION:
In Gallons
Total
Gallons
# of
Manufacturer's
Prefab.
Site
Steel
Fiber
-
Plastic
Exper.
New
Existing
Tanks
Name
Concrete
Constructed
glass
App.
Tanks
Tanks
Septic Tank or
Holding Tank
.2000
aodo
I
AJ/rser' Cwx,
t/
Lift Pump Tank /
Siphon Chamber
VII. RESPONSIBILITY STATEMENT: A ,
I the undersigned, assume responsibility for installation of the onsite sewagesystem shown on the attached plans.
Owner's Name(s): (Print) If applying rorSeclionCabove
Owner's Sr . (N St ps)
/p6,aj Tom.
•-w
Plumber's Name: (Print) Irapplying for Section Aora)above
Plumber's Signature: (No Stamps) I
MP/MPRSW No:
A HclA fo/ko c/-;.
aao O
Plumber's Address: (Street, City State, Zip Code)
Home Phone:
Business Phone:
/'O ,.Gue 62.2 Sr, R%v-r, 1v'%3''8t/7
VIII. COUNTY I DEPARTMENT USE ONLY
Approved
❑ Disapproved
❑ Owner Given Initial
Sanitary Permit/Transfer Fee:
Date Issued:6RA112
Signature / Date,
� %r �7
Adverse Determination
3
IX. CONDITIONSOF_APPROVAL./ REASONS FOR DISAPPROVAL:
-rwt4 fig.'/, /1 f 7i't
p c
/ 440 cecfrr p f �44,'n / - / Plot Plan on reverse side
Lot Line
2.
3.
4.
5.
6.
7.
SEP 16 2026
Bayfeld Co.
etannin9 and Zoning Agency
£x151 r,0 ?-ODpj. ' -1 - rcl� ue"l S
Ca'c. r-cfc_ / V ' ccGd .& 7
ybra;.6 %M1 ��
O
U
— 4tr o%,5c It;
4 Name of Frontage Road ( Co fl w y
9 fl je_ ) _�
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 I holding tank to well - n.
Drain field to lake, river, stream or pond
g. Septic I 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
13 YFIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-4010
Property Owner:
Description
Sanitary Revisions
Submission Number:
CS -00190
Transaction Number:
CS -00190-558C1
Amount
$25.00
Total: $25.00
Payment Amount: $25.00
Reference: 5185
Paid by: Fred J Fabian JR / Susan V Fabian
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
SIGN -
SPECIAL -
- Vault Privy
CONDITIONAL -
BOA —
No. 26-0501 Tax ID: 26219
Issued To: FABIAN, FRED J JR & SUSAN V
Location: S31 - T49N - R09W
Town of ORIENTA
Legal Description: NW SW IN V.1136 P.341 683
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Residential Structure in F-1 Zoning District
For: Sanitation Permit —Vault Privy [2000 Gallon] [Previous Permit #26-100S & 20-0091]
(I)isclaimei ): Any future expansions or development would require additional permitting.
Condition(s): Took out composting toilet & placed outhouse atop holding tank that also services cabin.
You are responsible for complying with state and federal laws concerning construction near or on wetlands, takes, 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 Tracy Pooler, AZA
work or land use has not begun.
Authorized Issuing Official
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. September 17, 2026
This permit may be void or revoked if any performance conditions are not
completed or if any prohibitory conditions are violated.
Date