HomeMy WebLinkAbout040-1101-80-001 i iii
11111111211
Tx:4240311101119111
32 9 '
Document Number
Document Title
1009689
St. Croix County BETH PABST
REGISTER OF DEEDS
Occupancy Affidavit ST. CROIX CO., WI
RECEIVED FOR RECORD
Garoie K. Su wl i e.r 5uj4 �. S t nn e r 03/27/2015 3:37 PM
st EXEMPT #:
Name— (Owner)Typed/or printed REC FEE: 30.00
being duly sworn,states,under oath,that: PAGES: 1
1. He/she is the owner/part owner of the following. arcel of land located in St.
Croix County, C05 I HD Document
Wisconsin,recorded in Volume Page
Number $l LN 3 St.Croix County Register of Deeds Office: Recording Area
Name and Retpm Address
A parcel of land located in they IN V4 of theSE ''A of Section 25 Cr 4 r o Id K. S aril e 1"
T 2S N—R -I°I W,Town of "f12-0% ,St.Croix 130 ra k i s O it Ka-
County,Wisconsin,being duly described as follows(include lot no.and R i ye y. Falls, idi c<f a
subdivision/CSM or detailed legal description):descr ipt io n):
p T 3 0 C sM Vol . 2 3 ?( 5'82b V l 1 _ go _
0 , I
Parcel Identification Number( )
'OpLVrw..n'F N € - 3i:S1 Li Lii-
A owner of the above described property, I acknowledge that the septic system serving this residence is sized for a
bedroom home,or a design flow of (-I51) gpd. The design flow is calculated by assuming 150 gpd for 2
individuals per bedroom. There are currently occupants living in this residence; occupants are permitted
based on the design flow. Therefore the septic system serving this residence is code compliant. However,I
understand that if there are intentions to exceed the number of permitted occupants,the system will need to be
modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make
this information available to any future parties interested in purchasing this property.
Dated this�l day of / v`-GLc --0/S. 1/
.b-efrf-0-4* * Gar01.1 K. Suryner
```��11A111,14_ 5„..40.....—a L vl_ L1! V IA* 5 tin «,r ir-
AUTHENTICATION bA/". «•• ''•r S ACKNOWLEDGMENT
�. J 1 STATE OF WISCONSIN )
Signature(s) O�A Y
>
•Z: St.Croix County. I
��
authenticated this day of `N j i t� Personally came before me this day of
:.(1 PUBS iO. ��-�r0/d ek'. £named e( f .2U$ Py
TITLE: MEMBER STATE BAR OF WISCONSIN 5�i�0 t tl N�```` to me known to be the person(s)who executed the foregoing
a uthorized by§706.06,Wis.Stets.)( not, insttum•• - • acknowledge the -me.
a
THIS INSTRUMENT WAS DRAFTED BY
aro.h "t�roher // rw ....- _
* _i/�!
Notary Public, to of Wisconsin
(Signatures may be authenticated or acknowledged. Both are not
Commission is permanent. If not,state expiration date:
Orate: OR _02 - r9-14 necessary.)
THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE"
This Information must be completed by submitter: document rifle.name 6 return address,and au of required). Other in formation such as the
granting clauses,leagal description,eta may be placed on this first page of the document or may be placed on additional pages of the
document.Note: Use of this cover page adds one page to your document and;200 to the recording lee. Wisconsin Statutes.59.517.
St. Croix County 1009689 Page 1 of 1