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HomeMy WebLinkAbout020-1337-40-000 r ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner 41,0,6 —Ay Address City /State Legal Description: Lot Block --- Subdivision/CSM # 6' X ?,3Vc�,E' '/4 /1/W 'I Aee , Sec. I_V, T I, fN -R/J'W, Town of o PIN # D 20 — / 33 7 -- Yo SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Gd '�-r�S Size ST/PC/ O / *9Setback from: House 2,7 Well ,-SV P/L Pump manufacturer 21wl-4 _ Model ' g;a a Y// Alarm location �S�lrsr/l. (HOLDING TANKS ONLY) Setbacks: Servic d Vent t es air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: 4:5 Width /F Length s 5 ' - � Number of teaches Setback from: House Well 7 75 P/L Vent to fresh air intake _ ELEVATIONS Description of benchmark I'Jv /� Ce/�l //'mac ,�^ Elevation 1po 0 Description of alternate benc k ° B/" Elevation Building Sewer fZ. 5r ST/HT Inlet 9 7-5 - ST Outlet 7 7.3 PC Inlet 19 7. •� crow PC Bottom Header/Manifold l03, /.Z Top of ST/PC Manhole Cov Distribution Lines O /D 2. f 2 - RECEI Bottom of System ( ) /o .2 - _ 1999 Final Grade ( ) ( ) O sCOU�x J' � �;`1,, Date of installation nu er State plan number Plumber's signature License number s A f/ ,*0 Date /s77, Inspector Complete plot plan sr I NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW / � s SGT of � TreC o h' INDICATE NORTH ARROW ,� 4f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST CRO X Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338 Permit Holder's Name: ❑ City ❑ Village %] Town of: State Plan ID No.: BAST, KERNON HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9900066 c t. 3 o� TYPE MANUFACTURER CAPACITY STATION I ELEV. " Septic 2�O Benchmark Dosi ng l�-� !3 y . �z I.08' Aeration Bldg. Sewer Holding St / Ht Inlet `j.gi? g5% (. Z TANK SETBACK INFORMATION St/ Ht Outlet !p, o S �f TANKTO P/L WELL BLDG. Airi to ntake ROAD Dt Inlet (a to S . to irl Septic aq' > 5'D a r' ---- NA Dt Bottom 13.(:4 91 g Dosing Sa > SD 3S 35- NA Header / Man.,d 5-C1 74 ( Aeration NA 4 Dist. Pipe :er. s Qz c v,oy Holding Bot. System cicl q fig' PUMP/ SIPHON INFORMATION inal Grade 2. Zz Manufacturer C., Demand 1 , $ o ` Model Number v, 1 1 L� a� GPM , TDH Lift 13.g Lriction System TDH 1b .75\Ft mead oss Forcemain Length I5 1 Dia. 2 u Dist. To Well >5 SOIL ABSORPTION SYSTEM BED TREW;H Width ' Len h ► N f PIT No. Of Pits Inside Dia. Liquid Depth EN I N, S DIMENSION SETBACK SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Typeo , ► CHAMBER Mode Number: System: �" • I O r > SO ) .SD '—' OR UNIT DISTRIBUTION SYSTEM Header /Manifold c, Distribution Pipe(s), It r x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 6 Dia. Spacing 3 7 7 _ 1 11 >.5b SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes U No . COMMENTS: (Include code discrepancies, persons present, etc.) 3 !'S LOCATION: HUDSON 14.29.19,NW,NE 989 DROVER TRAIL - GRASS RANGE LOT 4 [1 80 �3 g -�''c� l d�.►��wcpeaP- "�"� -G Plan revision required? ❑ Yes ❑ No Use other side for additional information. I a 3n SBD -6710 (R.3/97) Date Inspector's Signature grt . No. 'fo „�►�y Safety and Buildings Division Vi ITARY SC011S%11 SAN PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County i than 81/2 x 11 inches in size. S/. C • See reverse side for instructions for completing this application State Sanitary Permit Number 3 Personal information you provide may be used for secondary purposes Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner N me Property Location ;V 114 _ 1 /4, S / v e T N, R a E (or ` Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or C19M- ItUmber ( >TsC- W A YPE BUILDING. (check one) E] State Owned ❑ it ge Nearest Road Cl To a ` Public 1 or 2 Famil Dwellin - No. of bedrooms Town of III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 7 — 3 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 Q Mobile Home Park 12 Q Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. 0 New 2 ❑ Replacement 3_ Q Replacement of 4_ Q Reconnection of 5 ❑ Repair of an ------ System -------- System -_ Tank Only Existing System Existing System B) V A Sanitary Permit was previously issued. Permit Number �1,?Xe03 Date Issued 34—t9 V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Rf Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Q Seepage Trench 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy 13 E] Seepage Pit Z yXNc( 8cD 43 ❑ Vault Privy 14 ❑ System -In -Fill fir, _ Ta ^ w,=Vp 0/ rC,E46 VI. ABSORPTION SYSTEM INFORMATION :,,Oe / Aw AMW PCjrt0rXv 4tz ff 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System El 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) py.7 ' Elevatio �00 s'p p Feet d&o // Feet Ca acit VII. TANK in gallo Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New fxistin strutted Tanksl Tanks Septic Tank or+lelrf Tg1vrA( 2A .;a Gv� �r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /$*herrE comber A ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oft nsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Sta W"PRSW No.: Business Phone Number: vxr Plumber's Address (Street, City, State, Zi Code): / Y© IX. COUNT / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Ag Signature (No Stamps) Surcharge Fee) / A;pe f^ Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber DAVE F06ERTY PLUMBING Licensed Pork Tester & Plumber #3233 #3289 4 Fogerty Heights Road � ROBERTS, WISCONSIN 5402 N Phone 74 - /T Ilk M i / h n ® , OO - A 0 I � 11 JJ I' 0 I✓ - , ^ C n � ,� W •I f ►J o � oC ti h c► ' NO o ` VI o �` f o 0 r n �c N ' ' PAGF C;F PUMP CHAMBER CROS5 SECT 101,1 AMC) SPECIFICAr10QS VEA1T CAP `I��C.I. V'E!�T PIPE WEATHERPROOF APPROVED LOCKINIG � 25' =ROM DOOR, JUUCTIOU BOX MANHOLE COVEF rir WIUDOW OR FRESH 12 "MIU. AIR INTAKE GRADE I I `1 MIM. coA1DU1T 18" Mlu. \ 11 , I/JLET PROVIDE _T AIRTIGHT SEAL i I *` A I � I I I I ALARM a I II I o *APPROVED I ou JOINTS WITH I I ELEV. FT. APPROVED PIPE - -j 3' ONTO PUMP -� OFF D SOLID SOIL ` GOAICRETE BLOCK RISER EXIT PERmTrED OQLy IF TAUK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFI DOSE TAUKS MAM UFACTURER: 4-11rrec- NUMBER OF DOSES: Z PER DAy TAMK SIZE.: _ POD GALLOMS DOSE VOLUME ALARM MAAIUFACTURER: S• i . L� CECI7L/ IRICLUDIAIG B ACKFLOW: .3/9 GALLONS MODEL I.IUMBEK: _42Z t/• w. ZAiy.E• e ! 1. r CAPACITIES: A= (z_ UICHES OR 3Y0 GALLOWS SWITCH TYPE: h? B= 2- I OR _VZ GALLOWS PUMP MAMUFACTURER: G C= __CfL_ INCHES OR l GALLOWS MODEL MUMBER: - J,4r7bO D= INCHES OR 4W GALLOWS SWITCH TYPE; ei � ,� �''i1��-�� MOTE: PUMP AIJD ALARM ARE TO DE MI►JIMUM DISC H I AR _ GE RATE 20 GPM INSTALLED ON SEPARATE CIRCUITS I VERTICAL DIFFEREAICE 15ETWEEAI PUMP OFF ARID DIS RI TD O � -� I I T BUTIOAI PIPE.. FEET � + MIAIIMUM METWORK SUPPLY PRESSURE z?-l�- • • • • . .. . . FEET + // FEET OF FORCE MAIM X ! ; y F Joo FLFRICTIOU FAGTOR..___C_L0_ FEET TOTAL D HEAD FEET I Al E ^' �• T RUAL DIMEAISIpAIG OF TAA1K: LENGTH S • —;WI .� — ;LIQUID DEPTH ,r3 SIGUED: LICENSE DUMBER: DATE: .IL MODEL • ' • '14 '1 Su bmersible • GOULDS i I � r i y� p ump Specific t10 y�af�C- METERS FEET Up�to, Ll �G . r MODEL: 3871 Discharge size 1 f. IV y T ���_ - 9 , gV Solidse maximum V'­ - t or 3 x �' t . �, 8 Mot y� s 7 Single phase115V = ° Materials of C nstructlon ; = 6 20 Brassrthermop�stic ; 5 15 Features and Benefits EPOS 5o usGR" *Top suction eliminates 3 10 impeller clogging. 2 EPOa • Corrosion resistant 5 construction. Float 0 • actuate 0 10 P2� 0 switch. 0 o i 4 6 e 10 "z Wm, METERS F CAPACITY FEET MODEL DVP03 Pump Specifications Features and Benefits In 5 20 4 /10 and /2 HP • EPO4 impeller- semi -open design 5 Up to 60 GPM with pump out vanes to protect 4 15 Maximum head to 32' mechanical seal. , Discharge size 1' /2' NPT • EP05 impeller - enclosed design Solids: 3 /4' maximum for improved performance. 5 Motor •Rugged glass - filled thermoplastic All motors feature ball casing and base design provides bearing construction. superior strength and corrosion ° 0 0 5 10 15 20 25 30 35 40 U.S.GPM resistance. Single phase: 115V U J. CAPACITY 6 8 1010'm' Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. - g SANITARY PERMIT APPLICATION 20 Safety and s 1E.W shn Visconiin m. Code P.O. Box 7969 Department of Commerce acco w ILHR 83 O5, Wi s . A d Madison, WI 53707 - 7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. _ C e See reverse side for instructions for completing this application State sanitary Permit Number y ou p rovide may be used b other g overnment agency programs � 3 �� 0 1 - i s The information y p y y g g y p g C heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Na a Property Location pj1 /4 11, 1 /4, S , N, R E Property Ow is ailing Address Lot Num er Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 1 ( 7/5 7 >74 — 7 7 fd<fC' II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road Vi la Public Vf 1 or 2 Family Dwelling - No. of bedrooms Y ❑ Town OF o c try III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 2A. 19.1'1 Q 1 ❑ Apartment/ Condo O•� /33 -- `�� 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. Vr New 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an System System Tank Only Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 [] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit ,?' 0 , 2 se 3 ❑ Vault Privy 14 ❑ System -In -Fill re F ..t646 VI. ABSORPTION SYSTEM FORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed Lq. ft.) (Gals/day /sq. ft.) (Min. /inch) 9f/.7 0 Elevation A ve rIf �D Feet , O / Feet Capacity VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Se eptic Tan ❑ ❑ El El ❑ El Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ I ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of^ onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: p PRSW No.: Business Phone Number: u ber's Address (Street, City, State, ip Code): d 4P t ©�- IX. COUNTY DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing ent Signature (No Stamps) PApproved ❑Owner Given Initial °1�f Surcharge Fee) Adverse Determination �Z� (lam 1 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6M (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber I DAVE FQGERTY PL M61 e A t 2 Lkqnsed Perk Tester 6 Plumber oT s #3233 / 3289 F Heights Road ROB£P elS�C40g,36'3H6 3 J�d6 - 777s- 2 yv X _ WI Q rbp o f S E LvT S tr} /cF � 4 jo? OF NE Lor sr *lX fi I. -to' G � .1 �f TE'it.t�iRT y O = 1 ou G/f+� S t vTlf Tiff N�� X _ • = ir9auD GoT CozvER»s / % � �t �'•e+,r G = w6GG a so ' F/t Owr /3cc p `, L.n+�E k o► IY x y ---- �ti - - - - -- -- —�' 7& M C AL-C OaAl -) Fd1z LeT 0.7 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 020- 1020 -90 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT NW 1/4 NE 1/4,S 14 T 29 N,R 19 it (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # LaBarge Rd. __4 na Grass Ran a Addn. CITY, SATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE [gfOWN NEAREST ROAD ( Hudson McCutcheon Rd. �c] New Construction Use [ x] Residential/ Number of bedrooms 3 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gp d Recommended design loading rate • 7 bed, gpd /ft . 8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate - 7 bed, gpd /ft - 8 trench, gpd /ft Recommended infiltration surface elevation(s) areaA =94.8 B =95.8 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem [3 S❑ U 13 S❑ U I JE1 S❑ U g] S❑ U [3 S El U ❑ S n u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTmnch 1 - Ground 3 15 -8 elev. 96 ft. Depth to limiting factor +82 Sy . Remarks: Boring # 2 Ground 29 elev. 9 8.0 ft. Ilq-R9 Depth to limiting fac GE{ Remarks: MAY 2 1 1997 CST Name: -- Please Print Gary L. Steel Phone: 715 - 246 -6200 t�• S7 CR Address: 1554 200 ve. New Richm d WI 54017 ZONNGOPP Signature: Date: 5 -1 -97 C� \ PROPERTY OWNER Kernnn Ract. SOIL DESCRIPTION REPORT Page of 'i_ PARCEL I.D. 0 02- 1020 -90 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 — Ground 3 11— elev. 98 ft. Depth to limiting factor +80 Remarks: Boring # 2 10-20 10yr4/4 none Ins 0SCI mvfr 9K if .7 i.8 Ground 3 20 -30 10 r5 4 c2 7.5 r4 6 sicil lcsbk mfr aw if .2 .3 elev. 9 9.1 ft. — Depth to limiting factor +80 Remarks: Boring # _ 5 Ground 3 19 -80 7.5 r4 6 none cos 0SQ ml na na .7 .8 elev. 9 8.8 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -9 10 r3 3 none sl 2mcfr mfr 9w 2f .5 6 6 €' Ground elev. 9 9.6 ft. Depth to limiting factor +B2 .1 Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Kernon Bast New Richmond WI 54017 �4�4 S14 T29N - R19W MPRSW 3254 town of Hudson (715) 246 - 6200 lot #4 - Grass Range Addn. 1 11 = 401 � A BM.= top of SE lot stake @ el. 100' Alt. BM.= top of NE lot stake C el. 86.20' �t l � F� rl f !D� t 1p ✓, ,. 1� 31 �05 a l' Gary L. Steel 5 -1 -97 i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND /, OWNERSHIP CERTIFICATION FORM Owner/gwfer- /�- _�,Iew 9r 7_ Mailing Address Property Address 7XArG (Verification required from Planning Department for new construction) City /State /t_ cti� Parcel Identification Number 6 LEGAL DESCRIPTION Property Location ' /,, A�F ' /,, Sec. I q TAN- R-Lf INT, Town of uo • Subdivision G .+( S AAt/d:fG , Lot # _ • Certified Survey Map # - , Volume , Page # Warranty Deed # S'2 , Volume 1> ..? V , Page # S J y Spec house ❑ yes - (to Lot lines identifiable yes ❑ no SYSTEM MAI Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a. treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. live, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da s 'f the three ar elviation date. , I P,,z _ SI N TUBE O&APPLICXNT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty descri dab , by virtue of a warranty deed recorded in Register of Deeds Office. h SIGNATURE od APPLYANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa * * * * ** ** Include with (his application: a stamped warrant deed from the Register of Deeds office Pp p Y B a copy of the certified survey map if reference is made in the warranty deed I V141"T kt} � �r .x. �` + Tit* ..,cs ■aewom sow "mstewaww DA TA . j r � k Z • ' Y T' f � f "� fs Vii 10E �,.IO y*r.�'..�rg.«+MN,.�«u rMeR�rfiM" ..� ..,a..+ ._ .ai..ay'T•;:: «: +..*.r.i,..:•. - z - � � r ., •e +.gr. ., ,5+... x .�''�+s ±...t+c.r +•enxs .....• - . - ... . �� ,.� yyy�.yy��.. Fr t i a � � � , �' � ._ '� CAF �t'M•''�e .'D�'f R L �.. �' Y � ys� �f if . �`- $ 1 01. -19 'ltoa�te Mt2K ie Pai. 9'�e. r. 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' 2.5' W N 0 W D O \ O O• t0 0 • (D 1 m m \ p 0 , Q ca N 3 W N OD OD O O ♦ I A Cn OD (0 O � d _ I r CA ' O 0 I ICJ w m ° x om 1 m n u) .p I 1 � ( W W m 1 o W I 1 1 250.00 I 167.61' 82.39' 479.26' S00 ° 21'48 "E 824.26' I 0 T 3 L 2 Each , parcel shown on this map (plat) is subject to State, County Township laws, rules and re gulations egu ations (i.e., wetlands, minimum lot si: access to parcel, etc.) . Before nurchaai nQ nr HPVPI nni nR nri - %r