HomeMy WebLinkAbout018-1083-27-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division �k Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitn,RRra111GGbb�o tNo.:
Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)].
Permit Holder's Name: ❑City ❑ Ila e T n of: State Plan ID No.:
onte, Ronald arr�. 6hY "ownship - —
CST BIVI Elev.:- Insp. BM Elev.: BM Description: Parcel �a;c Nq 83- � 1 M , Q , • U ttSS 1U
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Q (TAO Benchmark 00
Dosing t. BM 1o3.9S
Aeration Bldg. Sewer 2 . a-0 03.3 I
Holding St /Ht Inlet . '
,S; c� cro 3g
TANK SETBACK INFORMATION St/ Ht Outlet 6 • ! 0 9• a'
TANKTO P /'L WELL BLDG. Airl to ntake ROAD Dt Inlet
Air I
Septic 5-0 r 39 1 1 — NA Dt Bottom --
Dosing NA Header / Man. 7.057
Aeration NA Dist. Pipe
Holdin Bot. System L 10. Zs r 4 D
PUMP/ SIPHON INFORMATION Final Grade _
Manufa r nd St cover I•so 10 ZD
Model Number GPM
TDH Lift L oss Ion Sys TDH Ft
H
Forc ain Length Dia. Dist. To
SOIL ABSORPTION SYSTEM 6
RENCH Width Length O Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIM I 3 8• �. DIMEN I N
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING MIctuq re�:
INFORMATION Type O r r , CHAMBER Mod N umbe
System: Cy - L ti > to OR UNIT
DISTRIBUTION SYSTEM
Header / Manifvo `L Distribution Pipes) x Hole Size �xHole Spacing Vent To Air Intake
Length cti Dia T 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 Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: ( In lu code scre an i r t e ns ec ion
Location: 983 17 ntre i, amrr�on�c g �� p (�?l 4$ W 1/4 27 T29N R17W) - 16.29.17.599 Pheasant Hills -Lot 27
1.) Alt BM Description S Iq �.,a -x-�
2.) Bldg sewer length= t` -e--. ii, l'�,r.- 1,►�.. -.� �lSS haw, �i Iy
- amount of cover = *> l8"
Plan revision required? ❑ Yes Q No
Use other side for additional information. p I 60 9t
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
Visconsin SANITARY PER ON 2 01 W Washington Avenue
P0 Box 7162
Department of Commerce In accord with Co 8 Is. Adm. � , Madison, WI 53707 - 7162
• Attach complete plans (to the county copy only) for \ �System, not,4 County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing thl ap p licAi�r f State Sanitary Permit Number
3 ?-0 Z 0 0
Personal information you provide may be used for secondary purpo s X ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)] 9 P3 W2 �7 f . State Plan Review Transaction Number
I. APPLI ATION INFOR ATIO PLEASE PRI INFORM. .
Property Owner Name F rd ovation ,��
/R.o T i alt% V S lr� T a i N, R /7 E ( oc
Property Owner's Mailing Address Lot Number Block Number
/44 s a 7
Cit , State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE OF BUILDING (check one) ❑ State Owned 0 Cit Nearest Road
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town of 1 oe r 7 D s
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s
0 th' -l0,p 0v0
1 ❑ Apartment/ Condo t 2 - 1 7 . S9
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. &New 2 Q Replacement 3. ❑ Replacement of*- 4_ ❑ Reconnection of 5_ Q Repair of an
- _____S�fstem ________System - --- --- - - - - -- Tank Only _ ___ - - - -- Existing System -- - - - - -- Exis ---- - stem -
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 Typ 41 ❑ Holding Tank
12 [jSeepage Trench 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy
13 ❑ Seepage Pit X 43 ❑ Vault Privy
14 ❑ System -In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Syst Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
�� !l ✓ ✓, ,rrj F ` 3 Feet
Ca cit
VII. TANK in al allo s Total # of Prefab. Site Fiber- E
INFORMATION g Gallons Tanks Manufacturers Name Concrete con- steel glass Plastic xper.
App
New Existin structed
T nks Tanks
tic Tan or- Kel�iwg dank ❑ El ❑ ❑ ❑
/S iphon Chamber El El 1:1 1:1 ❑
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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: (Nq Stamps) i M RSW No.: Business Phone Number.
1)' 1fl'e S�!ajn4 a r
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved I Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
Approved []Owner Given Initial Surcharge Fee)
Adverse Determination # Z Z.S. 6 & Z U G
X. CONDITIONS OF APP OVAL /REASONS F OR DI APP O
C ' e ' x ' e ' x 9(c , AP. a S l 4t 57 / L �� Ae/�J
SBD -6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety $ Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a 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(SBD -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 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
ll. 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 on 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 for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks 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 plansand specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the foltovving' 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 contamination investigations
and establishment of standards.
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Wisbonsin Department of Commerce nRIGON I L AND SITE EVALUATION Page I of 3
Division of Safety and Buildings in ac rd with Comm 83.05, Wis. Adm. Code
Certified Soil Testing
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (B oun
M), direction and y St. Croix
percent slope, scale or dimensions, north arrow, apologation and distance to nearest road.
-- T' r_,,, Parcel I.D.#
APPLICANT INFORMATION - ft4dse print all inid')Tation.
Personal information you provide may be uss"d for secondary purposes (Privacy�uw, s. 15.04 (1) (m)). Rev' d Date 00
Property Owner s.a Property Location ci
Bonte, Ron Govt. Lot NE 1/4 NW 1/4 S 16 T 29 KR 17 W
Property Owner's Mailing Address 1 '' ZHU c_T I Lot # Block # Subd. Name or CSM#
1011 170th St. " ,T ROIX 27 Pheasant Hills
City SW Zipp code 0 AlbRfi 0 r city City n Village ®Town Nearest Road
Hammond 5401 I)II 524Q • 'l1- ammond 170Th St.
_ New Construction Use: 4 sid ntal: /iNUmb` bedrooms 3 ❑Addition to existing building
Replacement ❑ Publicbr comrrr6rclal describe
Code Derived daily flow 450 gpd Recommended design loading rate .3 bed, gpd /ft2 .4 trench, gpd /ft
Absorption area required 1500 bed, ft 1125 trench, ft Maximum design loading rate - bed, gpd /ft - t rench, gpd /ft
Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar
Additional design !site consideration install 2 - 5 ' x 112.5' shallow trenches on contours in lower half of surveyed area (upper half is suitable for at-
g s grade or mound replaca meet) fn* _'t hr
Parent material till Flood plain elevation, if applicable, NA ft
S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ® ❑ U ® S U ® S U ® S❑ U ❑ S E ❑ S Z U
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trench
1 0 -4 • 7.5YR 2.5/1 - sl 2 m gr ds cs if .5 .6
43 f
2 4-18- 7.5YR 2.5/1 - sl 2 f sbk mvfr cs if .5 .6
Ground 3 18 -29• IOYR 4/4 - sl 2 m sbk mfr gs if .5 .6 ✓
elev
99.7 ft 4. 29 -44- l OYR 4/4 - sil 2 m sbk mfr cs Im .5 .6
Depth to 5 44 -55, l OYR 4/4 c2d 7.5YR 4/6,5/3 sil 2 m sbk mfr cs Im .5 .6
fmiting 6 55-75. 1OYR 4/4 f2p 7.5YR 5/8,5/3 sl I m sbk mvfr - Im 4 .5
44'
Remarks: mound or at -grade indicated by this profil@
2 I 0 -5, 7.5YR 2.5/1 - sl 2 m gr mvfr cs If .5 .6
2 5 -10, 7.5YR 2.5/1 - sl 2 f sbk mvfr cs Im .5 .6
Ground 3 10 -24• 7.5YR 4/4 - sl 2 m sbk mvfr gs if .5 .6
elev
99.7 ft 4 24 -37• 7.5YR 4/4 - sl 1 m sbk mvfr cw if .4 .5
Depth to 5 37 -62• 7.5YR 4/4 - is 1 m sbk ds - if .7 .8
limiting
factor
>62'-
Remarks: occasional gr, cob, & st in horizon 5
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715- 665 -2681
Address
ertt to of esttn a
P O Box 57, Knapp, WI 54749 4 1 2 227 Number Re 1069
PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT [ Page 2 0 ' 3
PARCEL I.D.# Certified Soil es ti .
Depth Dominant Color Mottles Structure GPD /ft
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots
Bed Trench
.................._.
3� 1 0 -3 . 7.5YR 2.5/1 - sl 2 m gr mvfr cs if 5 6
2 3 -12 - 7.5YR 2.5/1 - sl 2 fsbk mvfr cs if .5 .6 ✓
Ground
elev 3 12 -30. 7.5YR 4/4 - sl 2 m sbk mvfr cs lm .5 .6
98.3 ft 4 30-40. 7.5YR 4/4 - sl 1 m sbk mvfr cw if .4 .5
Depth to 5 40 -60. 7.5YR 4/4 - Is 0 sg dl - - .7 .8
limiting
factor
> 60" 4 01 �
40.
Tr
Remarks: some gr, cot), & s t to Horizon
4 1 0 -4 7.5YR 2.5/1 - sl 2 m gr mvfr cs if .5 .6
2 4 -8 • 7.5YR 2.5/1 - sl 2 f sbk mvfr cs If .5 .6
Ground
elev 3 8 -24 - 7.5YR 4/4 - sl 2 m sbk mvfr gs lm .5 .6
99.0 ft 4 24 -34 • 7.5YR 4/4 - sl 1 m sbk mvfr gs 1 f .4 .5
Depth to 5 34 -52. 7.5YR 4/4 - sl 0 m dh cs - .3 .4
limiting
factor 6 52 -60. 5YR 4/4 - sl 0 m dh - - .3 .4
> 60"
Remarks:
5 „ 1 0 -4 . 7.5YR 2.5/1 - sl 2 m gr mvfr cs if .5 .6
2 4 -18 • 7.5YR 2.5/1 - sl 2 f sbk mvfr cs if .5 .6
Ground
elev 3 18 -35. 7.5YR 4/4 - sl 2 m sbk mvfr cs IM .5 .6
96.9 ft 4 35 -46 • 7.5YR 4/4 - sl 1 m sbk mvfr cs - .4 .5
Depth to 5 46 -60 7.5YR 4/4 - Is 0 sg ml - - .7 .8
limiting
factor
> 60" - N
-414 0
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Remarks: gr, F745, st Below
Ground
elev
Depth to
limiting
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Mad 22 00 10 :22p Ronald Honte (715]- 796 -5240 p.1
S T CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
( i\ OWNERSHIP CERTIFICATION FORM
Owner /Buyer 11\ Q ona%C C.
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Mailing Address 10 1
m # L f + S (793
P
party Address - )-O�' r`�A�cr�.,� )4 ti 1 I
- �� 4, ." acv j
(Verification required from Planning iDepattment for new eonslructloo)
City/State Ho M imOv �L Purger Identification Number `' t4 '6
4(aa - Ivd� - ,Oat
LEGAL DESCR E N L 7 Z 4. ��•
Property Location N L V, �� V., Sec. �0 . T2 N -R 1 W, Town of a rf\m p y�
Subdivisicra U ��SmyY t , �i S Lot # - 7.
Certified Survey Map //# _ Volume . Page 0
ra
Warnty Dead # 6 � a� S y '7` Volume __ 7 , page #
Spec laattsa 0 yes O no Lot lines identif'iablegym 0 no
l_ Ia+ptoper use and msLit�mmeef your aeptie s"km could torah in its prcmatnr -biium to MAU wastes. Proper rmiateoance
saeaists of pvaopim out the septic t wk every thee, Yom ar sooner, if needed by a iteecsed pwMer. WL%t you put into the system
eau affect tba f an of the vapdo tank as * treatment stage in dw waste disposal $j%teem.
The proptay owttor AV= to submit to St C roitt xoaing Drpa UOW It attifieation fotstt, rigged by the ownerw and by a
tnasterplember, jonsntyatattpltaarber, aaatetadpltaaberor s lteeasedpuatpervetify►ing that tho on - site wastcvratardisposat rystam
is' POM Operating condition and/or (2) atler laspoetion and pumping (if necessary), the septic a* isle= clam 1/3 Cuts of dwgt.
Uwe, the neximignedhsro scud tho above requltamelts sad agtoe to min the ptivaW sewage disposal system with the staodtrds
sat forth barelq, as sat by the D4%WLM ant of Oommeroe and the Department of Nau-W Resourecs, State of wise uLm Ccrd4 motion
silting that your septic system bas beers waia W*d mot ba completed and remmed to to St. Croix Conaty Zoaiag Of6ee tvithip 30
AT da of the slum year imitation date.
SIGiYA'It1RR OF wPPLlt:AN'r DATE
O
Y (we) cere&Y Wit all statements On this form ate true to the best of my (our) imowtedge. i (we) acs (are) the owner(s) of
the+ ptoporty des�pdbext abov virteu of a waoaeaty dead recorded In Register of Deeds Oft9oe.
SItiNATURE Olt APPI:ICANT
5 ,aq oo
DATE
04.664 Any info=etion that is Otis. mpraentedmay result is the sanitary penult being revoked by the Zoning Depattment.
.1
*• Include trill, tide application: a stamped warranty deed from the Register of Dctds *Met
a copy of the certified sorvey map if reference is made in tlee wamw(y decd
�jWd9S :16 eow 8'c 'F ti65 6V2 S14 ' 'ON BNOHd ONI `SHCI - IE bn0 i 100 -' d : WCbJ
-' aE 3 arm'' i '' �-
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VOL 13 7 9 9 pw 444
i STATE BAR OF WISCONMN F')RM 2 — 1992 KATHLEEN H. WALSH
r : ¢ WARRANTY DEED REGISTER OF DEEDS
Sl. CROIX CO., wl
DoC U'nENT NO, RECEIVED FOR RECORD
a'
Roger E. Lind is_t_and_JunQ_L_._lindcuist __ 592188
� — _flllShaild�[ld�tLfp •– ` _ — � 11 -23 -1998 9:30 AM
Il _ - --
�'! WR4NTY DEED
conveys and warrants to Ronda_C R�nte --nd -Dingy M_ Bant.e,.__ —. RECORDING FEE: 10.00
,. husband and wife � surv ivQrshia mar_iLaL _property__ DFSES: i a
kr
TH,j SPAI:E RES`e R FCR RECORDING DATA
NAME ANG r7ETURN ACCRESS
the folloccing described real estate in St. Croix County;
State of Wisconsin:
FIRST NATIONAL BANK OF BALDWIN
' 990 Main Street
The Southwest Quarter of the Northwest Quarter, except Baldwin. WI 54002
ik
the West 363 feet of the North 600 feet;
The Southeast Quarter of the Northwest Quarter;
A, G 18- 1034
All in Section 16, Township 29 North, of Range 17 PARCEL ZENT NUMB; —
West (in the Town of Hammond). 018 - 1035 -00'
TRANSFER
FEE
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This is not homestead ptoperty
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its nut)
Exception to warranties:
t
rte,
Dated this 19th day o f Novem
y -- A.D.. 19 -98.
- -- — iSEAL) `7' — r`•
• Rog er E. !i
— - -- —_ (SEAL) L*L r Lt r (SEAL)
• ne L. Lindqui
AUTHENTICATION ACKNOWLEDGMENT
Sign: •ure(s) State of Wisconsin, `
3
St. Croix County. ;s
authenticated this clay of l9 Personaliv came bef_ me this 19th
day of i
Novemb 1958
tile alx
oger E. Lin
R d ul
. `_7<. an June L.
'
1 -.Lind ui h b a n _
TITLE: MEMBER STATE R.AR OF WISCONSIN : n
(If nut, ; —
authorized by §706.06, N& is. Stats. ` I — a
tq a 1tr.o.cn c, be the person $__ who executed the furrguut�+ a'
4_t . i i J ;1Ctr $ rntckno ledge t sa.
THIS INSTRUMENT WAS DRAFTED BY S � 'Q� aeaee•� �� �
Marl -0 —Dobbs fuht/ ID N R - RQBBEP.Ell � 1<YiS� O – - -- -
"'��rts�w�t Daniel G Schm
4 25 E. LaSalle Ave. , Barron, WI 54 Count Wis
_�— NotaryPubli_, St. Croix
(Signatures may be authenticated of acknowledged. Both are not My commroton is permanent. (!f not, state expir.'tuon dale
necessary.) Ph //(715) 537 -5636 101201 2nng
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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
1 N M N N N N■ r�ri ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016 -7710
(715) 386 -4680 Fax (715) 386 -4686
October 10, 2000
P.C. Collova Builders
Attn: Laurie
705 County Trunk E
Hudson, WI 54016
RE: Septic Inspection for Ronald Bonte located at 983 172nd Street,
Pheasant Hills (Lot 27), Hammond Township, St. Croix County, Wisconsin
Dear Laurie:
A septic inspection of the above referenced property was conducted on September 21,
2000. This property is located in the NE 1/4 NW 1/4 of Section 27, T29N R17W,
Pheasant Hills (Lot 27), Hammond Township, St. Croix County, Wisconsin. At the time of
the inspection, this septic system was found to be code compliant for a three (3) bedroom
home.
If you have any questions regarding this, please contact our office at (715) 386 -4680.
Sincerely,
Kevin Grabau
Zoning staff
/sm
cc: file