HomeMy WebLinkAbout020-1342-10-190 (3)Community Development Department – Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov
SANITARY SYSTEM
OWNERSHIP/ADDRESS FORM
Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. Owner/Buyer
Mailing Address
City/State/Zip
Phone Number (required)
Email Address (required)
Parcel Identification Number (found on the property tax bill)
Property Location _____ ¼ , _____ ¼ , Sec. _____, T _____N R_____W, Town of .
Subdivision Plat: , Lot # _____.
Certified Survey Map # , Volume , Page # .
Warranty Deed # (before 2006)Volume , Page # .
Number of bedrooms Spec house yes no Lot lines identifiable yes no
New Property Address (Verification of new address required from Community Development Department for new construction.)
/ / (Staff Initials) (Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed.
NEW SYSTEM: LEGAL DESCRIPTION
File #: ______________ Office Use Only Created 2/2021
OFFICE USE ONLY
OWNER/BUYER INFORMATION