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AS BUILT SANITARY SYSTEM REPORT
OWNER J--m YY►:11 mr TOWNSHIP h- /s ati
SECTION Z/ TEf_N-R~
ADDRESSBOk-f~7fZ-, ST. CROIX COUNTY, WISCONSIN
SUBDIVISION {/ci/~ t- (,/ST LOT z LOT SIZE a X07
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
.\o I i I
i
d
N r P
6~ I s'
fbaS~ . ~ I
~~icSO
loJaf m IS- O /D S
1~iC 3Lr ~~S'
1
Z,
G , 1
W y(k,1 / 135 "?(°O i
R 95 (No Spa
B.M. ~ ,P~~l• _ lgooa
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: 30
r
Alternate benchmarkfRP
SEPTIC TANK:Manufacturer: "is*v- Liquid Cap. Oo<na,1
Rings used: Z Manhole cover elev:_Final grade elev:-,("
Tank inlet elev.: S~q~r Tank outlet elev.:
9-
No. of feet from nearest road:Front , Side,,,~_, Rear Ft.s'
From nearest prop. line:Front , Side_, Rear,' Ft. /0S
No. of feet from: Well 6,5"
, Building: ZS/
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP
i
SECTION T N-R_W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
BENCHMARK:Elevation and description:
Alternate benchmark
SEPTIC TANK:Manufacturer: Liquid Cap.
Rings used: Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side , Rear Ft.
From nearest,prop. line:Front , Side , Rear Ft.
No. of feet from: Well , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
Ai"t e1/;571~t Gel' y3
PUMP CHAMBER
Manufacturer:i Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front, Side,, Rear-Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: 6,e yd,,t-V,4rench:- Seepage Pit:
a 'Width: Length Number of Lines: Area Built ZvS 77
Exist. Grade Elev.-6,p< Proposed Final Grade Elev. -d~
Fill depth` to top of pipe: `f z
i
No. feet from nearest prop. line:Front Side X , Rear Ft.L
No. feet from well: -O No. feet from building S21
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front Side , Rear Ft.
No. feet from: Well ; building , nearest road
Alarm. Manufacturer:
INSPECTOR:
DATE: PLUMBER ON JOB:
LICENSE NUMBER:
6/90:cj
i
I
> w
~a
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP
SECTION T N-R W
ADDRESS ST.,-CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
BENCHMARK:Elevation and description:
Alternate benchmark
SEPTIC TANK:Manufacturer: Liquid Cap.
Rings used: Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side , Rear Ft.
From nearest prop. line:Front , Side , Rear Ft.
No. of feet from: Well , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
LOCATION HUD~SOdTT 21.29.19.1262 NW SE PRAIRIE' ' LANE, LOT
Wisconsin Depart A to In ustry, PRWATV SEVVAG E SYSTEM Coun23
ty:
Labor and Human Relations
S54ety and Buildings Division INSPECTION REPORT ST. CR IX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
175642
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
MILLER, SAM HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
a7- 1111,41 pg 020-1260-90-000
TANK INFORMATION ELEVATION DATA A9200301
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 3 1063 /00. 0
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet S °l 3Z'
TANK SETBACK INFORMATION St/ Ht Outlet 3 R 7
Vent
TANK TO P / L WELL BLDG. A
ir Ito ntake ROAD Dt Inlet
Septic / ~Js l 02~~ ~S / NA Dt Bottom
Dosing NA Header/ Man.
~,7a S"g
Aeration NA Dist. Pipe Cf,~S c~ 3s`
Holding Bot. System ~D S
PUMP/ SIPHON INFORMATION Final Grade 7,
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING manufacturer:
SETBACK
INFORMATION TypeO -yx-4o CHAMBER r Mode Number:
System: 79 OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length - Dia. Spacing &
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 CenteW Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 10,
k
UQA-
,7
L"'4-
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. /
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
D~LHR SANITARY PERMIT APPLICATION couNTY -
In accord with ILHR 83.05, Wis. Adm. Code
m ~~^^-mss
STATESANITA PERMIT#
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑
8% x 11 inches in size. Ch k If rev sion to prew us ap ation
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
G ~~ld.: n o c W Y4 SE '/4, S / T L y, N, R E (or~
BLOCK #
PROPERTY OWNER'S MAILING ADDRESS LOT #
90 z fL 2-3
CITY, ST TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
30n IS-1000'1,4 3 eZ G a. it- f)% S'r
II. TYPE OF BUILDING: (Check one El State Ow CITY NEAREST ROAD
ned ❑ VILLAGE
r5n TOWN OF: ~4 30 ~is.riQ sti`
❑ Public 1 or 2 Fam. Dwelling-# of bedrooms -=a-- PARCEL TAX Nu B R( )
Ill. BUILDING USE: (If building type is public, check all that apply) aQ Z q
1 ❑ Apt/Condo
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 in line A. Check line B if applicable)
A) 1. [A New 2. ❑ Replacement 3.0 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 - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 rVI Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) , ELEVATION
y51'd 72.0 720 O. & 2 961, 5 d Feet 99, ?4 Feet
VII. TANK CAPACITY Site
in gallons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank DOD Ve..% a
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps MP/MPRSW No.: Business Phone Number:
Dam st a b~ 40 -Af A f 3 3
Plumbe 's Address (Street, city, State, Zipp Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent Signat No S
urcharge Fee) 8~~7
Approved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
41. A sanitary permit is valid for two (2) years.
2.' Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (S13D 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
Il. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, nur}ber of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. CorrFlete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only i` anks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- - - - - - -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
S T C - 100
This application form is to be completed in full and signed by
the owner(s) of the property being developed. Any inadequacies
will only result in delays of the permit issuance. should this
development be intended for resale by owner/contractor,(spec
house), then~a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
Location of property l/4 5 1/4, Section
Township aJ-Ca"A
Mailing address _&Bv , 0,~12
Address of site 1~ra r (a Go'f' #L~?
Subdivision name/a; Lot no. Z3
Other homes on property? yes No
r
Previous owner of property JeF-1 ' cr
Total size of parcel J• 07'~Date parcel was created 3(~ L
Are all corners and lot lines identifiable? Y_Yes No
Is this property being developed for (spec house)?Yes No
Volume-735-and Page Number `f ss as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I(we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of
the property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. V1142-1 , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
recorc~ ed in the office of County Register of deeds as Document
No. yl DyZ!
Signature of applican Co-applicant
z
G~~'tX!/1Li~ .
Dat of Si nature Date of Signature
16f, Stewart ................»r Perils" Sapreseatative of the state
x~sm........... I ~f~.,,
i .:.Lk~I..S1XSt..x(F!!A I 9:45 Arr:
............»..................._.....................("Deaaeat").
• i
i fsr a Valnalis emd"mmen eeavgs. witleoot marrenty. to Verlyn,- E, BetfQy
a9.»WKd0k.
.
g S? lC~X..ll ~k.. ..Af..lfµilt Y4r4~l p
Grantes, asru ♦o
St. Croix
~real estm , in M .............................Cotmt7A
w dc:. . (ibulinafter called the "ps roper ri ) '
,
" West Half of,: outh East Quarter of Sectiap 21,
Tax Pared No:..........
To
vrstship 29,` 19.
1
r
t0
t;
f'
A
Yr -
Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property wise!
whist
the Dsedwt had immediately prior to Decedent's death, and all of the estate a- interest in the Property
Personal Representative has since acquired.
Dated this 28.0............... - day of - Maxr-h ..w I0..
1
„.1.~: '----.-1~ . .........(SKAL)
:.........(SEAL)
a . iar.ry -1 ..C.4u!s?.CG L. irk
Personal ♦
Frnoo~l R••vre..n4tiPersonal Ra•prvaenLtive l
Is.
Ism.
AUTHENTICATION ACSNOWLEDG To y4
J. !
Sicnature(s) STATE OF WISCONSIN M~0 ,..Q .
♦ sit
at... Croix.... County.
authenticated this ..--....day of.... _ 19 Personally came before me this Y28th...da ,et
~ta.rcb ts.86... the above aesaed
_ - Harty. J...$Lewsir.ta--as..Ye>;&RA~~.- ~81«J9~A ativl;.:
• for the t':4tat(t.-Pf John A14KQAYx.AJ*ATj1.4•a•
TITLE: MEMBER STATE BAR OF WISCONSIN a/k/a John Aldro .Larsen, _a/k/a._Aldro
(If not, Larsuii _
arthorized b;: § 706.06. Wis. Stated r t~ me k oan to be the pers who executed the
fore instrumrut and ackW%v/)eedR.- the same.
THIS fv STRUM F-NT 4AS ORAFTrO PY LC_ ~YLtiiM~ - {H
Lois A. `lurray of HEYWOOD, C,1KI S MUKKA1' 4
. 7 f~ 11~ l . I UQ~~.S.''.
P.Q. box 229, 11uAlsuu. .la;L 14016 tiotn-v I'uhhe St. Croix County.Rfip. t a
(SiRnaturt- may he :ntthenticated or neknowk-&-rod. K th %Ic Commission is pcrmatent. (if not, s to expiradea
are not n• -ary•) date t / T 19_if~
kn
.Nrmw of p-r- - .irnlnr in a:~y -a- sty 0""'A L. I'[-, ^:.:.1.-l l,.L w 0,
iTM BAR OF W1444 ONSIN wiaeoMM
malromme. y
liasOMAL 17Yia DixD Aesl Nw S - !9tl= V- weak,-0
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 14,(;116. 4-3 e4, o y Sa ~1~~Q✓
ADDRESS __,~ox z~Z FIRE NUMBER
CITY/STATE ,/rat e`en ~U ZIP_-'T-
PROPERTY LOCATION: (fLll/4, 1/4, SECTION Z/ , T-,
TOWN OF ~tct _SO-v, , St. Croix County,
SUBDIVISION a, LOT NUMBER Z 3
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 septic tank pumper. What
you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant
for a maximum of 60% of the cost of replacement of a failing
system, which was in operation prior to July 1, 1978. St. Croix
County accepted this program in August of 1980, with the
requirement that owners of all new systems agree to keep their
system properly maintained.
The property owner agrees to submit to St. Croix Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or a licensed pumper
verifying that (1) the on-site wastewater disposal system is in
proper operating condition and (2) after inspection and pumping (if
necessary), the septic tank is less than 1/3 full of sludge and
scum.
I/We, the undersigned have read the above requirements and
agree to maintain the private sewage disposal system in accordance
with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be
completed and returned to the St. Croix Co. Zoning Officer within
30 days of the three year expiration d e.
SIGNED*
DATE:
64- r
St. Croix co. Zoning Office -77
911 4th St.
Hudson, WI 54016 ~
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 5
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
• • COUNTY C
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but "rTCR61x
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.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION Q
-SAM 1LLE GeYr-tOT t4w 1 45E 1/4,S 2t T Z9 N,R / 7 E (or) W
PROPERTY OWNERS MAILIN DDRESSLOT # BLOCK # SURQ NAME OR CSM #
l 4nW
C STATE ZIP CODE PHONE NUMBER ❑CITY (]VILLAGE OWN N AR T ROAD
New Construction Use ] Residential / Number of bedrooms 3 [ ] Addition to existing building
,dA j ] Replacement [ J Public or commercial describe
Code derived daily flow 50 gpd Recommended design loading rate d. 7 bed, gpd/ft20$ trench, gpd/ft2
Absorption area required 7 LO bed, ft2 trench, 11:2 Maximum design loading rate 7 bed, gpd/ft2 0__trench, gpd/ft2
Recommended infiltration surface elevation(s) 75.SU ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable It
S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE S,~YsTEM IN FILL HOLDING T MK
U= Unsuitable fors stem WS ❑ U 6(S ❑ U S❑ U t~ S❑ U kSJ S❑ U ❑ S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
L M 5bl~ r ,4
-zh
1-7
Ella! It P, 474 1 m -sk
Ground $ 19" joZe 0 ow ni f C -0:7 6..%l
elev. S m C I O.
Depth to
limiting
factor
>Z
Remarks:
Boring # L I r►t 5 bK r C' Z 04. S
we 'Z C Z .Z 0.3
1 10.7 10.1
Ground "546 Jet Q _
elev.
7„ ! Yt0
1ft.
Depth to
limiting
factor
,67
Remarks:
CST Name:- Haase Print Phone: A~a
Address: Wo ,
Date CST~Numb ~r.
2L!L L
Signature
PROKMOWNER -!-w- uep' SOIL DESCRIPTION REPORT Page Z of 3
PARCEL'IA #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Y, g r -Z
oy~e 3 6 S, C 0.2. p.
Ground ZQ~ tvt -7 6.f$
14 o6 3ft. /bY S
10,~ .0--6
Depth to
limiting
factor
10
Remarks:
Boring #
W 16 Y4 -Z /-Z- L I
hi• 4
0
S^EG y,, C, > 4 O ~6
Ground Zz-« I &P, 414
0 9A
p,~ Og
epp 6Zft. $ -76 /aY4 S 5 ;11
Depth to
limiting
factor
>
Remarks:
Boring #
S
AYR 4/4-
Ground gZ 24 ~ / Y 4. 4 5~ Ctrl C 0;7 b.56
1 eft. 9 R S o. O~
Depth to
limiting
factor
9! .1 .
Remarks:
Boring #
~:2 4'33
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
46303
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REPT131 . HUDSON ST. CROIX COUNTY ZONING PAGE 1
09/22/92 11:44 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/22/92 AREA: MJ
Activity: A9200301 9/22/92 Type: CONVSEPT Status: PENDING Constr:
Address: HUDSON 21.29.19.1262,NW,SE, PRAIRIE, LANE, LOT 23
Parcel: 020-1260-90-000 Occ: Use:
Description: 175642
Applicant: MILLER, SAM Phone:
Owner: MILLER, SAM Phone:
Contractor: STROHBEEN, DOUG Phone:
Inspection Request Information.....
Requestor: STROHBEEN, DOUG Phone:
Req Time: 14:09 Comments: "1
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION