HomeMy WebLinkAbout26-0502CS- o0 'S9
BAYFIELD COUNTY
SANITARY PERMIT APPLICATION
Zoning oletdct
Lakes Class
I. APPLICATION INFORMATION
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No: 1 0O— Oq
Property Owner's Name:
Permit No:
Roo .t r E 7 a v{ M yLvi E D.4S2- 2-
County: Bayfleld
Address of Property:
Property Location:
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4� 31S IiVyccw' I/(4 (Lo( lAth i'!Jt S4Zzi
S Y. Y.,S 31 T41 N,R to E (or)
Property Owner's Mailing Address:
Township: I Gov. Lot #:
2l1( W 4" S
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CityA State Zip Code Phone Number
hAeo 01 L ,MN c 4to �1159�-91(44
Lot # IBlock #: CSM #: I CSM Doc # I Subdivision Name
5 CEIVED
II. TYPE OF BUILDING: Check One
State Owned Tax I Dtk I (/ q' D
❑ Public (Explain the use/purpose t
ENiEBEUE@ Fj 226
1 or 2 Family Dwelling - No. of Bedrooms z q is 1
II. TYPE OF PERMIT: Check only one box online A. Check box on line B if applicable) BargeGO.
A) ❑ New ❑ Replacement ® County Private Interceptor Planning anti LflhlIIYA"/
❑ Repair ❑ Revision '" ❑ Transfer of Owner (List Previous Owner below)
B) A Sanitary Permit was previously issued. Previous Permit Number 005 Date Issued: S I Zco I Zoo
IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) • Replacements need previous permit number and 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. ABSORPTION SYSTEM INFORMATION:
s 2. AbN3,,3. Absorp. Area 4. Loading Rate 5. Perc. Rate I 6. System I 7. Final Grade
y Re) Proposed (Sq. Ft.) (Gals. / Day / Sq.Ft.) (Min. Inch) Elev.(Feet) Elev.
(Feet)
D (p
TION:s Total flof Manufacturers Prfb. SiteFiber
isting Gallons Tanks Name ConcretConstructed Steel -Plastic Expecanks
ooldinqTaank
glass APp.
nk orank00 �aSMusSty%�
UN Tank /hamber
VII. RESPONSIBILITY STATEMENT:
I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Owner's Name( a): (Print) Itappyingorsecnoncabove n attire(s): (No Stamps)
Plumber's Name: (Print) it applying for Section A orB) above bar's Signs (No Stamps) SW MP/MPRNo:
t 'Y!V/.3' f+ 5 111 S,2FN
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Plumber's Address: Street City State, Zip Cce)
122.C �4Y/fN4
Home Phone:
Business Phone:
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7/S 779 -3/.S
I 7/ S"-590-eZJ--1
VIII. COUNTY /DEPARTMENT USE ONLY
❑ Disapproved
Sanitary Permit/Transfer Fee: I
Date Issued:
a nature / Date:
Approved
[I] Owner Given Initial
Adverse Determination
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IX. CONDITIONS OF APPROVAL I REASONS FOR DISAPPROVAL:
Plot Plan on reverse side
RECEWV'ED
SEP 152026
Bayfield Co.
planning and Zoning Agency
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AYFIELD 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
Private Interceptor
Submission Number:
CS -00189
Transaction Number:
CS -00189-55973
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 700
Paid by: Robert J Deisz / Megan E Deisz
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 - Private Interceptor
SIGN -
SPECIAL -
CONDITIONAL -
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
No. 26-0502 Tax ID: 16910
Issued To: DEISZ, ROBERT J & MEGAN E
Location: S32 - T44N - R06W
Town of GRAND VIEW
Legal Description: N 200' OF S 500' OF N 1/2 OF GOVT LOT 5 IN V.1025 P.521 593B IM 2004R-494753 IM 2003R-487218
Residential Structure in R-1 Zoning District
For: Sanitation Permit — Private Interceptor
(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 Scott Roush, AZA
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.
Authorized Issuing Official
September 18, 2026
This permit may be void or revoked if any performance conditions are not
completed or if any prohibitory conditions are violated.
Date