HomeMy WebLinkAbout020-1491-10-000 (3)- 5i9N —ao 19 — 394
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CountyMan" Permit Application
ST. CROIX COUNTY WISCONSIN
In aa-ord with Chapert 12 St Gm& County Sanitary Ordmanx
PLANNING 8 ZONING DEPARTMENT
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Personal information you provide may oe used for secondary purposes
ST CROIX COUNTY GOVERNMENT CENTER
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[Privacy taw. S. 15.04 ,)(m)]
1101 Camrichael Road
Hudson, WI 54016-7710
(715)386-46B0 Fax(71SM6-468S
Attar xmplete plans for the system or paper not less than 8-12 x 11 inches m site
County Sanitary Permit * ❑ Check if revision to previous application
�H91-]a- o00
Applicabon intonnabon - Please Pnm all Information
Location:
roperty Ovine: Name
1/4 1/4, Sec / -3
N. R E (or)
n /J
/ 2j "-),
Property Owners Mailing Address
Lot Number
Block Number
j e
/0
City State
Zip Code Phone Numar
Subdivision Name or GSM Number
yC)
(?-rf /of/�u�s�r
1! Type of Building: (chock one)
dhv ❑Village,Town of
K 1 or 2 Family Dwelling - No of Bedrooms'`-
❑ PuolidCommercial (describe use).
Nearest Road _
❑ State ed
IL Type of Permit (Check only one box on Irne A Crack box on line B if applicable)
parcel lax Numbarts) i4r'
1.0 Repai- j Reconmzfi.r .❑Norrpiumbing ❑Rejuvenation
AI
Eanttatioc
0 ,2 `� %6 lG b 0005�
Permit Numher
Date Issued
61
❑ State Sanitary Permit was prewousry issued
IV. Type of POWT System: (Check all that apply)
EY Non-prsssurb:ed in -ground ❑ Mound z 24 in. suitable sail ❑ Mounds 24 in. Suitable soil C Mound At0
❑ Sand Filter ❑ Constmdec Wedanc ❑ Pea' Filter C Drip Lino
❑ Pressurved In -ground ❑ Holding Tank ❑ Singie Pass ❑ Other
❑ At -grade ❑ Aerobic Treatment Unit ❑ Raaru:ahng
V. Dispersat Treatmend Area inforrnatiom:
1. Design Flow (gpd)
2- Dispersal Area
3, Dispersal Area
4 Soil Applicahon Rate
5 Percolation Rate
5 System Elevation
7 Final Grade
squired
Proposed
(GalsJdsy)spit.)
(Mm.lmcn)
Elevation
. Tank Irdormation
Capaicry in Gallons
Total
# of
Manufacturer
Prefab
She Con-
Steel
Fibar-
Plastic
Gallons
Tanks
Concrete
struded
glass
New
Existing
Tanks
I Tanks
❑
❑
❑
❑
❑
IL RasponsibiBty Statement
1, the undersigmd, assume responsibility for repair/mmnnendionire(uvenationlmstallabpn of non-pWmbing for the POA7S snows on the attached plans. A
license is not required for tenal"dt repair or the instahation of non -pluming sanitation system.
Plumbers Name nM)
Plumbers ignatu (no stam�l:
�
MPIMPRS No
zz761/
Business Phone Number
/ Z76.,��21�
/tci� sla/
<K
Plumbers Address (Street. City State Zip Code)
Q c7, .� 1 `� .S i� i �✓ y ��
h County Use Only
Drsaoproved
Sanitary Permit Fee
Dam Issuec
issuing Agent Signature (No stamps)
❑ Approved
Owner Given Initial Adverse
Datarmination
IX Condlibons of ApprovallReasons far Disapproval:
Rev 8105
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K0407 51' I n .'�001 O
Impervious Covereae ?° / 1 h� I �e� 1
House/PorcWarage 3,128
Pole Shed 1,600 i� '' / /✓b 1,
Paeo,Deckvtandscagng 900
Dnvewav/Aprons 11 A00 L� f`C �IC'J N7 My4 J
Total Impervious 17,02E SF � ` d '
Lot Size 229,251 SF / J�/ a.m� ✓�' -:
PerceM Impervious 7.42 %
`O PAVILLION (7)'F)
Itx
BAIHPOOM (TYP)
WO(?q SH L) L e
° LOT 10
229,251 Sq. Ft. w
I 5.26 Acres d`
.;� LBO=1010.0 UU7 z.�
CBA=1.05 ACRES
_-, , RIB C''\, e.q. C9O
/G7L (CCESS
//// I 11 (� OUT pT
�J c� SOUTH LINE Of- THE HE
G� I 1/4 OF TI+E HE 1/4 OF -
SEC. 13, T29N, P19W
ISC 00' N N i 1 ,III n; � (D�/ 358.66'
R=679.97' i 35854
33 00
10
Site Plan
51
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