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r Parcel 020-1036-60-000 02/22/2005 12:54 PM
PAGE 1 OF 1
Alt. Parcel 18.29.19.157A3 020 - TOWN OF HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
JULIA A DILLON * DILLON, JULIA A
373 CASPERSON DR
HUDSON WI 54016
Districts: SC = School SP = Special / Property Address(es): * Primary
Type Dist # Description * 373 CASPERSON DR I
SC 2611 SCH D OF HUDSON S
SP 1700 WITC
Legal Description: Acres: 2.440 Plat: N/A-NOT AVAILABLE
SEC 18 T29N R19W NW NE LOT 3 OF CSM V Block/Condo Bldg:
4/1047
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
18-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1129/152 WD
07/23/1997 991/266 WD
07/23/1997 714/327
2004 SUMMARY Bill Fair Market Value: Assessed with:
47876 254,100
Valuations: Last Changed: 10/26/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.440 38,400 158,200 196,600 NO
Totals for 2004:
General Property 2.440 38,400 158,200 196,600
Woodland 0.000 0 0
Totals for 2003:
General Property 2.440 38,400 158,200 196,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 118
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
001-WATER SPECIAL ASSESSMENT 0.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
~ a
AS BUILT SANITARY SYSTEM REPORT
OWNER
TOWNSHIP SEC T?;; N-RAW
ADDRESS- ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION
LOT ? LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 146:3
- - Sf10.W- EVERYTHING WITHIN 100 F1.:ET OF SYSTEM
e
0A
Ir di ate North A rot j
SCALI.,:
L-
BENCHMARK: (Permanent reference Point) Describe: 13,/41
Elevation of vertical reference point:_ l Slope at site:
SEPTIC TANK: Manufacturer: y Liquid Capacity:
Number of rings on cover :
Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cycle gallons; tote capacity o
distribution lines gallon: size of pump head;
gallon per minute { horsepower brand name of pump
and model numb" r
'Type of warnindevice
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device 7 7
SEEPAGE PIT SIZE: er o pits feet diameter
feet liquid depth eepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines E width `0 le igth -S, g2ile depth
SEEPAGE TRENCH: width lengr-h
PERCOLATION RATE-' AREA REQUIRED 6 I AREA AS BUILT L/,,7 y
INSPECTOR y
DATED _ PLUMBER ON JOB
LICENSE NUMBER ~
OEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOAJ869 BUREAU OF PLUMBING
MADISON, WI 53707 ~
CONVENTIONAL ❑ALTERNATIVE state Plan 1l . D. Number:
Holding Tank F-1 In-Ground Pressure F-1 Mound 11t n.ipned
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Hanson Design & Const. 120 - 2nd St. Hudson, WI 54016
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. T. ELEV.-
NW4 NE4, Section 18 T29N-R19W, Town of Hudson
Name of Plumber: F RSW No.: County: Ssnilary Permit NumberRichard W. Hopkins RSW 1059 St. Croix 34782
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARN ING LA EL LOCKING COVER
ED: PROVIDED
" 7' J 7° L ❑YES ❑NO ❑YES ❑NO
BEDDING: j~ PROVID VENT DIA.: VENT MATL.: HIGH WAT NUMBER OF ROAD: PROPERTY WELL: ItSUILDINU: V IRENT TO FRESH
ALARM. FEET F
❑ROM i y LINE: / INLET.
YES NO ❑Yi5-' N NEAREST l 3 lA 3 J
DOSING CHAMBER:
MANUFACTURER: BEDDING: T01 ACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDEDPROVIDED:
❑YES ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PU PAND CONT. LS OPEgATIONA L: NUMBER OF PROPERTY WELL BUILDING IVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. eck the soil moistu eat the depth of plowing LENGTH DIAME TER AT L 440 M RKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN ,
CONVENTIONAL SYSTEM:
BED/TRENCH ETH EF F DISTR PIPE SPACING COVER- NSIDE DIA *PITS LIQUID
HES / MATERIAL: "r
DIMENSIONS PIT DEPTH
GRAVEL DEPTHISTR. PIP NoDIST NUMBER OF ROPE TY V NT TO FRESBE LOW PIPE ERPIPE NFEET EARESTM LINE` O / l"/1 A~~f
MOUND SYSTEM:
Mound site plowe d perpendicular to slop; Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: '
~mptmd systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑YES / p^ meets the criteria for medium sand. TIONS MEASURED.
O -
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
i
f ❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED EPT O RTR CH/8 D DEPTH OF TOPSOIL SODDED. SEEDED MULCHED
CENTER EDG /
r
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH WO. -OF LATE HAL SPACING GHAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DI ST PI E ANI OL A EHIAL NO DISTH DISTR. 1
ELEVATION AND DISTHIBUiION PIVE MATERIAL & MARKING
ELEV. ELEV.. DIA. ELE f PIPES DA:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING ORILLE.D COHHEq -Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
j'/ PLANS
' ' YES ❑ NO
COMMENTS: 3E'R' TMARK R C~YE ❑NO ❑ PROPERTY WELL: aU1LDING.
OBSERVATION WELLS NUMBER OF
YE LINE'
S O FEET FROM
U OYES ❑NO NEAREST
3•~y
Sketch System on
Reverse Side. Retain in county file for audit.
~i
TITLE
DILHR SBD 6710 (R. 01/82) y '
INDUST:VIENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 7969
HUMAN RELATIQNS
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: (or) TOWNSHIP UNICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME:
~~'/a/a ? IT < N RCS W
Ice
COUNTY: OWNER'S/BUYER''SNAME: AILING ADDRESS:
USE
DATES OBSERVATIONS MADE
NO. BEDRMS.: ICOMME I L DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
.Residence / aNew DReplace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: v: ❑U IN GROU p RE: SYSTEM-I L HOLDING TANK: SYSTEM:(optional)
1.S ❑U S (s ❑u S S
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:
G~ c Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROU DWATER ND DEPTH
ELEVATION N-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, A
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-
f;
B-
I
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH
P_ 12.
P_
P-
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 ancj-,stiow their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope,
SYSTEM ELEVATION ' y y ' ij f`t
_ e
r
3
v
a E
E
I - c
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON: Z) z2
ADDS S: CER~I I AT ION NUMBER: PHONE NUMBER (optional):
CST S,"NATURE
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soi' Tesie .
DILHR-SBD-6395 (R. 02/82) _ O,,
DEPARTMENT OF REPORT ON SOIL.. BORINGS AND SAFETY & BUILDINGS
INDUSTRY, - ON 6 BORINGS l1 1J DIVISION
LABOR ANY PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
(H63.09(1) tL Chapter 145.045)
LOCATION: SECTION TOWNSHIP/MUNICIPALITY: OT NC)]VK_ NQ.: S BDIVISION NAME
'A '/*4W /To!0/R / I W 4u c s.(n J 1044 air; SUie.v, A A P
COUNTY: 'OWNE Blipff NAME: Of U (L_D MAILING ADDRESS:
1 t57-- _6_&O . Soo TUsSl611J/ -CaAiS 1ZO Vj I S-4,0 / G
USE DATES OBSERVA OO SNTI MADE
NO. E3EDAMS.: CONFMERAL DESCRIPT 0NN:Il PROFil._E UES~(Pfil(TNS- PCRC0'LAT10N ES S:
Residence --LXNew EIReplace 21 3 71
RATING: S= Site suitable for system U= Site unsuitable for system
ONV[NTIONAL N1 0U D: IN-GROUN[}PRE URE SYSTEM-IN-FILL OLDING TAgNK: RECOMMENDED SYSTEM: (optional
'/1 I
9S EA 11Z"S ❑U Ms ❑U S L]U ❑S U I-4- P, 0 nJO trJG~. Pt~sF S
If Percolation Tests are N07 required DESIGNRATE: If an
/1 y portion of the tested area is rn the
under s.H63.09151(b)_indicate: -v C1.r~4rSS ' ~ Fluodplain,indicate Floodplain clevauon:
~l~„_, ~3~~`, ~7 PRO_F~ DESCRIP'fION5 ~UrrK!'•4l~~..DT ~,~,,IUS
BORING TOTAL I ~PTH TO GRUUNDWA"FER-t WEttrS CHARA( TER OF SOIL WITH THICKNE.>S, COLUR, "ff=XTURE. AND DEPTH
IAJMEtER OEP(H LEVATION OBSFRVEU EST. HI HEM TO QEDROCK IF OHSERVEU ISE_E AQBRV. UN QACK.1
1 -~t-~ o.(c t, 3nl LS, 1.(`U'j t3N MEOS, 1.95 Ko~N-SL, ~
B- I ? o o x.58 ~1 b ~J r y 001 O. O S
1 F3L 1-, C.S 4 J Bnt L-S~ I.~I'; 5~j MF0 S, I. SSrj g--D Bn/
B-Z ?,oo ~)-700 ~OhJF_ 7 -7r vv
V -FS, 0.10'j BN~~ w/r-Ib21L01JTAr.. ~ VmQ,T1(-KL SA,, DS~DBN V95. 2•4,r
13-3 5,51' Nor.l E C)4 .$3 SL L, 0,60'1~ 6H Ls y,oZ' f f314 MIE1>5, I,13'; G,
2A- G-( ^n o? r~ l.1 ' r3,u M (ZS~0"3Oil
i t L L, o.40~ 13.a LS) z.l o) ~r Nt¢a x. / 4.1 0'; r,, w, 0- 3 w Gam, 1. 4,-)
B- oa 83 ~1 a n.t 'y S. rz~
-f gL 4-1 O-S~ 13~~ t_{-S, I.(c~'; C3N Msa ~ w G2~ o.9o'J g~
B- 5' 6 so y -7, Z (o
S Z . 4cJ ~ ' D"~ Mts-,p S `~G ~ w //N PO 2 . M Orr, O , z0'' (~(y r.•[ Po +.t5
I-) O'C'1') Si,~.Z Pint MErz 1'70J P_z. %rj Sid O LAME SfO LT
8~J M~> S Cs Ge I, S(:)
PERCOLATION TESTS- IJUMBpE'!2. Gc~2.iZl55 N0.5 \A/ITN 60;kdN(14
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL--INCHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. PER INCH
P 1- ► :--o 1 5 3 3~~ %4 3 1
/ only
P- r ~Z- 71x(0
P-
P-
PLOT PLAN. Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
S Ni✓ Go L.
SYSTEM. ELEVATION `:4- • 3 a d ~.°T 3 a too r- -r. L , I
J i.
Pr1.t`C NA4Tit !
rN T . 1--Prl_ . X-p4 P_1►V 4 °~-1t.c~.Rr_ ! M I_ r I
' ~o f A~ c. c$ M o o rx't cr i W l ~pci.-} !
i Nfl1'V~ i I
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son tl _ I '
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gun C/U6 • ,B-I
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V12nP055 j 1`14 oME aRLC~fAl14l_ 7,r3 SQ. FT. 5 U 171401. is
1, the soil tests reported on this form were made pt.',he e in accord with the procedures and methods specifie 1 in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are corre best of my knovdledge and belief.
NAME: (printl _7ESTT WERE COMPLETED ON:
AD""` ~ - - CEH-)F 1~4 ION NUMBER: PHONE NUMLiEf optional.
CST; SIG'NA f URF:
DtSTRIBLITIONr I7;nlin7! am nnP rnp% to I „r it 4uth-)wV. Pm;in; ty (lvjwn r ),id F;oii Testes.
v •
L
E~F STHY, NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
J[JUSTFI DIVISION
AMAN RELATIONS ANDLATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 769
i;JMA07
N WI 537
IH63.090) & Chapter 145.045)
O CATION hT•--"- TOWNSHIP/MUNICIPALITY: LOT NO. tjLK_ NQ. SUBDIVISION NAME:
,V I*0 /8 /TAN/R ►W 4uD's(o/J .3 V .0aer,Suev. AAAP
{LINT9YN ME: -Or tJll- MAI N ADDR S :
' ~!b(116`. f4c t~ ~S C~ /J biS / 4
DATES OBSERVATIONS MAu[
NO. dLDF~ COhfM-t RZ,TAT))TS-M-FTIONI Prier-I E 1)ESOFiIPTit'SN-- VF-HCOLATION TESTS:-
esidence J? XNew L]Replace I '
R 3 I x/¢/93
ATING: S- Site suitable for system U- Site unsuitable for system
~IN~VENTIaNAL MOU D IN-GROUN[1PRESSURE SYSTEM-IrN-FILL OLDING TANK. HECOMMFNU EU SYSTEM:(optional
ICJS o~17 ~U ou S L~U I-b- P, PjJT OWNS. P -hS
T C ON V TfesN Tt ONi4 L
Percolation Tests are NOT required DESIGN RATE: If an - ' _
CL.IAtss ' y portion of the tested area rs in the
oder s.H63.09(5)(b), indicate: Floodplain, indicate Floorlplain elevation:
]>`cilL. S3C X:) (k 1~. S7 PROFILE DESCRIPTIONS ~yf`..K1-4P~ DZ. S=sI~...f
s
"MT
)RING E AI. PTH T R UNDWATER-"#C;- t~5 CHARACTER OF SOIL WITH THICKNESS, COLOR, T[:XTURE, AND DEPTH
JMNF.R pPfN LEVAI'ION OBSERVED _ HEM TO BEDHOC_K IF QBSFRVE_D ISF.E_ABBRV. ON BACK.)
i- I 001 mJ~isS3 N pnl F_ y OOI 13N LS, 1 Lc~'~ F3N Mco~S 1.9s J R.o rl SL r O.O
M6rc 5 1.8n' Bn, L S /4e, 1. oo'
3 z /Up t %7.00 (VO UUr PSL L, 0.54 j gN l_S~ 1.~1 Gl) 5
~7 l f. 85'J R D 6rl
1,4 /r V S, 0.10' ~N~S W Ho21LoNTAL VEQ,-r-Ir-PL- BANDS KDBN VFS,2rtoo'
I~L L O.(~p !3N L S Z.OZ ~N MTV S, 1.13 6 : S: w
-3 5.51 g8 5~~ N0r4E X4.83 2 C- . , /MPo
I y~apCN s r
Ut7~ , L L~ 0.40 t3..1 t_S L(0)f5 r MAD s, 4.10 ; i~N C' S ui Cwt= 1.40'
~ 7. ~3 b /~lF •'y' UCH
s bt t_, o, so 13, . f S, 1. ~a'; [3. Mtn S o'~ p,N
50 ~72. 1~1 nNE
- Mr>[>) S -z. 4-(),. t)" /AA PO Q.MpTT: p00004P0~,16
rLS' Dti Mao S 1.70'• 2p a^J S. r Sro -
7, 50 i ~
Mwr> S o 25 v:~,j CS w Gic 1. -0 J
PERCOLATION TESTS - NUMbIEIZ CCR.RMS11-oNDS W 1'I* boRWNc~
rE. DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-IN HES RATE MINUTES
:UMBER AFTERSWELLIN INTERVALMIN. PER INCH
~C1
3 .5 %4
- 2 - jLg-(•1W 1 s/it, I
114 YL. 7 ~(e
OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
~tal and vorsical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
land slope.
s s Nr: coe..
YSTEM .ELEVATION c)4---S 2loo _IF_T? :~vl
.o
13
wR.N r. I I
tcu>il~ Pir A C ec M 'h n; D ►~T p~r v i
-.141 -401
I
TN
JAN
EAQLX
socz
♦ sue ; voi. r
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I l ,1''11L N C4 r /h
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e2i/ •ti; ! I j / SPIKM IM Tt{aaI
et_
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rt I { I I j I. 1._.j- N fop o
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wb
aft
C/a- v - pQ,oPo ~ I N O
U ME T •
?tc.-Y r bRIC7111II~L 7,'5 0 SQ. FT, 5 U tTl48l.Z
soil tests reported on this form were. made b e in accord with the procedures and methods specihe 1 mthe
Wisconsin
,nrnistrarive Code, and that the data recorded and the location of the tests ure cores to the best of my knowledge and belief,
15 L_ u F---,
fVIF+rint~- TESTS WERE COMPLETED ON:
S. CE I I IF ATIONNNNOMBEA: PFIONE NUMBEf uptronall
Sm., N s~,.► l+ tea/ - - b~---- as o
cSi .4IGNA f URF:
/1 n
TRIf3tarlON7 n, r.tu+a: gnn nnP rnti+; in I .,r w, A,rtlrlrity. Prn{tr, IV llwnr•r nid Snil TCAt.11.
L
DEPARTMENT-OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR 41ND PERMIT P.O. BOX 7969
HUMAN RELAT!ONS- (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mailing Address:
/1 - 5 v /J /
Property Location: City, Village o ownshi County:
✓l~te'%4 ~t t/4S. / /T:~`' NiR f (or) W "
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or ndmar State Plan I.D. Num er:
Y
✓ t' „ (If assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ZNew ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Own is Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑Public 1)e 4
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Na a of Plumber: Signatu
f ~ 9 4AiP/MP3SW No.: Phone Number:
J/ ) Y6
Plumber's Address: Name of Designer:
I l ~ Gf t ,
COUNTY/DEPARTMENT USE ONLY
Sign re f Issuing Agent: e: Date: ftT-APPROVED Sanitary Permit Number:
v O-~f~~ ❑ DISAPPROVED Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81)
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