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HomeMy WebLinkAbout020-1174-50-000 n(o03 on d o A 3 N CD I Im 1 ID = _ N Z O W W C v N O• ~ N cu (n 0 r 4 go CL r) CD 0 co a d t_ N Cp 2 CD O '.7 ^ CD 3 W CD C 1 Q W N 7C' N 0 -0 Cp R m a p Cn O i -0 ~ pp p p K 3 N CD o p N_ N 7 r~ ~1 C (v I ~ cn ~ D ~ a m CD a:j CD N a w :3 N co c CD 3 ° `O V O C A Ln CD co (n 0 r- cn C~ G7 x y co 00 N N a c Co 2 . c. p P O Oi CL (D b O OOO? ~e (D ;rt 1 F- y3 o N o g ~y~~ p j y C~ I` t7 mp c N N y W H o o. a) COT ~DvOCl °g 00 G) (D CL 4- rr Z O c o trl (D ON (D CD F-- r7 N ~ ~ I a v41, Z N c z Z O D a y j CD CD N w c v, CD ' cn N Q Cr1 F-~ C CD CD d Ln W a I a 3 5 co Z CD -4 rn O ? Z CD N v CL W t\7-i O ON 7 _ ~I ~d W T rh C/] a CD co Z V 0 3 a A p C cn to r+ N U) N. N Z d 0 CD a C"' I~ ~Ksa 3 xN a m m =CD a 3 m c z a v o a =r N 0 w I _ d o 5 En fi N N C N Q O N 7 ~ a I 5D 7 O co to CN -.4 N 90 O = p all A o °p CD O p 0 A O ! y ti -Parcel 020-1174-50-000 06/06/2006 08:33 AM PAGE 1 OF 1 Alt. Parcel M 17.29.19.1096 020 - TOWN OF HUDSON Current X l ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HUTTON, MICHAEL J & TERILYNN J TR MICHAEL J & TERILYNN J TR HUTTON 923 RIDGE PASS HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 923 RIDGE PASS SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.473 Plat: 2627-WILLOW RIDGE EAST SEC 17 T29N R19W LOT 97 WILLOW RIDGE Block/Condo Bldg: LOT 97 EAST Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 12/13/2004 782323 2713/438 QC 07/23/1997 755/477 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.473 64,300 351,000 415,300 NO Totals for 2006: General Property 1.473 64,300 351,000 415,300 Woodland 0.000 0 0 Totals for 2005: General Property 1.473 64,300 351,000 415,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 209 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 G ~ IGJ D Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ^~Y LJG~SU.'~ SEC. f T N-RW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION -r - LOT_ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4,0G1~ 10A S5 Dt- ~M Sy -eAV_ E /.,-r 7 wAY P~pE t O E,u C E ss' q 3 18~ C~vE/C /0C7' II ¢~.~oP~~~Y L.vE d vER /00' ~i roc w [ , INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ,fvAd d iPE Elevation of vertical reference point: /o©' Proposed slope at site: / o SEPTIC TANK: Manufacturer: (,J) SEK Liquid Capacity: 2000 e~Al_ Number of rings used:- Tank manhole cover elevation: Tank Inlet Elevation:- g Tank Outlet Elevation: Number of feet from nearest Road: Front,(!j Side0 Rear, O 2,21 feet .From nearest property line Front 10Side,Rear,0 9!r feet Number of feet from: well, building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE t PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. 0 Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ~3 _ SD Lr~fU• Trench: Width: Length: 3( Number of Lines: 3 Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,( Pt. 0/0 Number of feet from well: "2, 33 ~C~' Number of feet from building:' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector:. Dated: Plumber on job: License Number : 6 3/84:mj DEPARTMENT OFiINDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 9969 BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL DALTERNATIVE State Plan ) Numbr (If assigned) D Holding Tank ❑ In-Ground Pressure D Mound 7NAME OF PERMIT HOLDERJADDRESS OF PERMIT HO LDER6 2 INSBjornstad and Harwell 910 St. Croix St. N., Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. T. ELEV.. CST REF. PI ELEV SW SW, Section 17, T29N-R19W, Town of Hudson Name. of Plumber MP/MPRSW No rs nty. Sanitary Permit Number. Gary Zappa 300 t. C roix 83796 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LI UID CAP CITY. TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ludo ~ W ;K~ES ONO DYES ONO BEDDING. VENT CIA. VENT MATIL HIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILDING TO FRESH AIR~L C ALARM FEET FROM LINE / IVENT YES ONO DYES ONO NEAREST DOSING CHAMBER: CKING COVER MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP.SIPHON MANDE ACTUREH WARNING LABEL LPLROVIDED PROVIDED. . YES ONO DYES ONO OYES LINO D GALLONS PER CYCLE: jPUMPANU1,UNTROLSOPERATIONAL NUMBER OF PHOPFHTV WFLI BUILDING VENT TOFResu LINE 11R INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ONO NEAREST- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH 1111AM, 1111 11ATf HIAt AND MARK IN(. or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: - WIDTH LENGT J NO. OF D ISTR. PIPE SPACING COVER JINSIDE DIA -PITS LIQUID HIAL: PIT DEPTH BED/TRENCH J / THENCHE 1 4) DIMENSIONS J (p (;fiAVEL DEPTH GILL DEPT[ DISTii PIPE DISTH PIPE DISTR. PI jIElN IAL STR NUMBER OF PROPERTY WELL BUILDING VENT TO FHI SH BF LOW PIPES ABOVE 'OVEN I I F I FEET FROM LINE AI I °'NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL COVER TIXTUHP PEHMANENT MA HI (MM HVATI()N WI I I S DYES ONO DYES DNO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH BEU DEPTH OF TOPSOIL SQIICF 11 SEE L1F 11 JMD CFNTEH DOESYES NO EYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING T1TAVCL7DE PTD BI LOW PIP(- FILL DEPTH ABOVE COVE R BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO OISTf/ I:I$TH PIPE DISTHIBUI ION PIP( MA If HIAI & NIAHKIN(i ELEV. ELEV. DIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING Df;ILLEU COHRFCiLV JCOVIN MATERIAL pE14TICAL L IF T CORHFSPONDS TO APPHQVID OYES LINO EYES ONO COMMENTS: PERMANENT MARKERS. OBS ERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING FEET FROM EYES YES ❑ NO OYES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SI a TITLE DILHR SBD 6710 (R. 01/82) y' ~ISCOnsn APPLICATION FOR SANITARY PERMIT J16~-~4 13 'LHR OUNTY (PLB 67) UNIFORM SANITARY PERMIT # - InauSTRV,LRBOR 6MUTRn RELRT1r]ns lCJ7/ 6 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS ° - Will In 6ft=-Ma?~ - _/y'101 ` PROPERTY LOCATION /Sl~ • ~ Lf1r~. L✓ 1/4.S ti✓1/4, S J T,29, N, R E (Or OW TOWN OF: .Ion/ j A, LOT NUM ER BLOCK NUMBER 'SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: 9 New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 9 Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity ,70 S Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: p IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): /.3 b S X Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: /MPRSW No.: Phone Number: ZAC,(,QA I za;;a~" 1 J00 ( S LI~P ';U Plumber' Address: Name of Designer: /1/ ) l s. `a 6 COUNTY/DEPARTMENT USE ONLY Signature of Issuing Age Fee: Date: ❑ Disapproved &021d- - - I /ys ~_/~Q(/D Approved El Owner Given Initial pl Adverse Determination Reason or ap al Alternate course(s) of Action Available: DILHR-SBO-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT STC-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 VJ O S--[ b Location of Property w _ s )14, Section 1 - , T Z:_~N-R~ W Township V c~)SO/1f Mailing Address 7-` 0(;0 Address of Site (E'-~C9 4 Subdivision Name Lot Number Previous Owner of Property ~n1eLD l )FCZ I ~1 S~ti) Total Size of Parcel Date"`Parcel was Created 2- LR (A Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes No -Volume (89 3 and Page Number 4(0 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, and 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) cvLaby that a t statements on this bonm cute t-tue to the best ob my (out) knowledge; that I (we) am (ate) the owner (s) o4 the pnopenty de 6 cA bed in this ,tnbonmati.on bonm, by vi tue ob a wwftanty deed neconded in the Obbiee ob the County Reg.uszen ob Deeds ass Document No. 39!502_c) ; and that I (We) pnesentty own the proposed site bon the sewage dispos System (on I (we) have obtained an easement, to nu.n with the above de,ScAibed ptcopehty, ban the eovustnuction ob said .6y6tem, and the same has been duty neconded in the Obbiee ob the County Reg.usten ob Deeda, as Document No. :?>Cis ~Zf~ ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) b / 1/1 DATE SIGNED DATE SIGNED H H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County z d a OWNER/BUYE M ROUTE/BOX NUMBER A~~ Fire Number .CITY/STATE A)DSON3 jC~ij&r:I*V1P WtSC&fQSttj ZIP 540140 PROPERTY LOCATION:,,~;E 14, Section, T_Z=- R~W, Town of 4 y C) S©/J , St. Croix County, Subdivision Li ' I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pot into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E ~ I/WE, the undersigned, have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S I G N E Da~~ DATE 7/11 /a, St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. v_ w M m -1 W m ~ O ~N p = p (D m m n n m= W o ° 3 -o`° SSw,~ '<u =01 3' R13 to CD '0 a CD O Q.Q0 W ° p ~ ((DD 1 tm CD CD 1 6 O CD O (p m oow A CL ~ O 3 cp O O 9 ca O w o~ 0 ~ S > > Cc c~.=UO) 3oc `Occ3O a w S m = =r :3 N O O p OL -u, _CD D cr co o w < (D (n Q CD U) C) 0 (n - CD ° O z= W n n (D°' o - aa= w o U) (o =Sow o' C N m NON CD C, w5D Z n n (o w (n D w CD CL m 0 3 C(D CD S a ~ D CO CD ~ a ° _ O M fl'i S C7 (4 I ::r 0. Cc m =r OL 3 (p O C0 _O, C m \At ° mcEr oma=m=S = m ° ~ c Q w 0 vi n 0 m f., w - CD O 1 O - C a O ;k N C° C C m a w O m w 3 w m = m a m= oL 0 CD CL lc<r ::r CD ~ N p L7 co : cD CD c CD 00 C 0 07% m o (D CD - :7 SD 0 CL m CL -3 CD o a O < 3 (CD Z O ~o r D&ARTMEN-ROF REPORT ON SOIL. BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR ND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) r LOT NO.:BLK. I-SUBDIVISION NAME: LOCATION: SECTION: TNSHIP~EITY: I NO 'ov OJ '/a `'/4 ' 7 /T~9 N/R E 4-;1 COUNTY: /BUYER'S NAME: MAILING ADDRESS: W.cx#'A z CEO fi uE T,p • ~v~fo v cv~s' rYO~ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence -3 F~ - New ❑ Replace - L RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) IES ❑u Qs ou ©s ❑u os E ❑s -U /d~'Y6 o/PAlu11hZv If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Ci L~sS Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-/ 94 P/ So 1~- ' 9Q w,e~ z -1.2-0 1 A o'P/V d4J • / z.S' i3~ - , S v-A ~f B-2, ' W o4M 1.73 eAJ S B`~ oill 01, 0...7 elf, 7W C.Ir 3AI > //o , B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD 2 PERIO PERINCH P_ "'.2- P_ Gr :1 U S 4/ -7c P- -C S 1AoI P AMP s P. • S ` L P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 6r sy5'7T;'j SYSTEM ELEVATION I _ 3 - - _ ass 'for a sf ['I ~PPA onvent[O6a s ~yo . E/o f- LiE'~ io, , i 1IJ 'l IN F~ E , -s fs OA.) 7Fs p i 3 I, the undersigned, hereby certify that the soil tests reported on this form were m e in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests c r e~t t t of my knowledge and belief. NAME (print): r ESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. JG ~L" - -/rOPG 'A Z" ADDRESS: ROBERT ULBRICHT j Q RTIFICAT ON NUMBER: PHO E NU ER(optional): MINN. INSTALLER & DESIGNER LIC. NO.OM6fi3 GNATURE-.DISTRIBUTION: Original and one copy to Local Authority, Property Owner an DILHR-SBD-6395 (R. 02/82) - OVER - J f ~ ''-'IT ICIS FOR C " _ETING O 115 - S BD - 6395 T ;ate soil t ust ii-14310 PI- ~ e t r erci<d L 7. 'Y YS Ar o, T- - W1 rVI 'I t i".. u i AmoGE PA rs 'I - E,'ZE6/7 N.E. L,TC.A.VL POT A vO ELLEE. EV. /60.00 RlFP/toPos~o wEt~ P/taPosE4 / AoJEcT GAnASe ' toAoPo-SHIJ ot 11 C, ~Li~~., I2~o~lll ~g .1'T. 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