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HomeMy WebLinkAbout006-1017-30-000 0 (n 0 K v ~ 0 -~v- cry, ~ m ~ m a s% m _ O i0 Z 'U o w C O o O w N uz C W O : (D O N O j (D 2, m z m n w ' o m Co o c m C n~ a ° k to * w C:) CT C, 0 0 (D C) CD CD o O O N N O r co N N p~ O A z D a r (D O V O. N CD N N Cn O O Ut C` (D N O m m (o m N O c (O (O (D 7 cT C 2 T * * * x (~j'tP~rr~iiiy 'Oa J N N m ®~s' A N N 71 O N (D M y S2° d 6 O 77 (D _ (D -4 Q N » O N N CD a O. a N O Z Z Z O D D O ~ c H ~r o' N rew • N N j!] N ' N G CL O CL Z O ~ V9 O O p Z N O ~ ~ n O Z O N Q O S Z -i co co '0 m z d ~ A 0 O Cl) N z (D A N ~ (D N+ N m I (D 0 CO N 7 F-0 O co to (D : T ' Q: (D v O N r: Z O ( 00 -0 Q O 0D 70 0 O iU r (D D O 2- C O Q O d O N N °-O_((DD a o 0 cm~. 0 N L. (D O D O (D (D N r -0 CD N , (D 1, 3 o W m 0 J D r r • 4~ C ~ (c yC J ~ r O O Q r +a Form Plb 67 Wisconsin State APPLICATION FOR PERMIT Division of Health for 3 PURCHASE OR INSTALLATION OF A SEPTIC TANK (Sec. 144.03, Wis. Stats.) aO - /Old U - C~l1b A. OWNER OF PROPERTY Type or use BLACK ink. 3/. Name Address Street, City, Zip Code i B. LOCATION OF PROPERTY Wf= SEPTIC TANK IS TO BE INSTALLED r Check 1. City bail address County one : 2. Village 2 AMA;4 3. L Town Give license number held: C. INSTALLER Wisconsin Restricted Licensed Sewer Plumber Services 7 ~I~ Name Address NEW TANK REPLACEMENT D. SPECIFICATIONS OF SEPTIC TANK Size in gallons: (Check one _ 1. 500 gal. 4. 1,500 gal. 7. 4,000 gal. 2. 750 gal. 5. v 21000 gal. 8. 5,000 gal 3. ;,1,000 gal. 6. 3,000 gal. 9. Dover 5,000 gal. give capacity Materials: 1. Prefab concrete 2. -Poured concrete 3. Steel j E. TYPE OF OCCUPANCY 1. ,-Single family residence 3. Commercial establishment 5, Other ~ 2. Multiple family residence 4. a Industrial establishment i F. APPROID,11ATE NUTIBER OF PERSONS SERVED DAILY ti G. PERCOLATION TEST MADE 1. L_'Yes 2. No Date 1I By whom (To be completed by County Clerk) Date application is filed and fee paid j-~ I Permit issued (date) Perrait Number J' Clerk ®r _ L_e y Y Vote: T'ie application cannot be considered/ for fiIir~, until all of the above questions are answered and the fee paid. County%Clerk will for.ar.rd application, the fee of $1.00, axed Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made pa.ynble to the Division of Health. Parcel 006-1017-30-000 06/15/2007 10:25 AM PAGE 1 OF 1 Alt. Parcel 8.31.16.111 B 006 - TOWN OF CYLON Current X 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 - GUST, ROGER W & MARION ROGER W & MARION GUST 2248 220TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 2248 220TH ST SC 0119 AMERY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.850 Plat: N/A-NOT AVAILABLE SEC 8 T31 N R1 6W PT NE SE N 185 ' OF E Block/Condo Bldg: 200' OF NE SE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-31N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 458/361 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.850 7,500 115,400 122,900 NO Totals for 2007: General Property 0.850 7,500 115,400 122,900 Woodland 0.000 0 0 Totals for 2006: General Property 0.850 7,500 115,400 122,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 55 CYLON T 31 N.-R. 16 W. _1~ POLK COUNTY 176 A Thom s ` / be F B~ 'o 0 `3O ~ s~Y~ < 9 ti r C/ate `1~, . moo' h ~~c c z~ ~3 T ~C ~ de o T ft 41 Lug/o ff ~V o 7v 46 ~o~~/> s<>~ s'- • T" ~o i> > , oi~ u/us /dc<i f ~s o/ _-7 63 • ~ /.co ~o . /ate ~ ¢o ~ o/' ,SedtP ,iP,c. ~o 1> > ~ / 5 r r ~~~f¢ 4a• lE fir. .y ~ ~ Er Theo. /~„y/ ve^ C Fria zs/ FF>, c o o c~ f^~ ARK Z. Al >U~ > icy' C ~4 / B m ht o sE ~4-beg- ~z d , m 7z go c.< I /ag > 9 A 40 1o f i Aso b Ci . ibo Gw~~c'• m • V , da _ ~ h t ~ 4~ ~ n ~ ~ ,E/uiin Ba /ae s~ ~ 4 t ~ IJen >c cPF/, qo J=~ T- _ ~41~ ~ @ e`~ C/>ek ~l 1, ~ / ~//Qm ~ AAA ~ ~ 3- «oi -h c` C ~ y P >/~e es¢ N ~ Eow 60 • 96ner >o l c'o.» - ~ ~ ~ ty .~o ~ L3~~Yo~ 9~ s • rs - L7 .moo%' ry Bel T. n ~ F /tee m¢ ie r- - f / 3 e~o~>e ' ~z .S/~ Sfan/ey . c Doc h h /ice ~ zao efai ~ /moo ~e ~e/h t Fouks d Q c7oh,~ 9 lO/f !.//pan ~~fes ¢y ~s / ~o f3u~ta / 9 <o ¢ e. cFy rsa T' cd - / o. ich av~✓e ~ e// ~4-oeber~/e~ • ~s ~o W v z: ~ ~o ~ 90 of ~yIVE.~ oc,E~so•~6o moo lwT ~~z ~ Yabe^ T,1,~ /~/f/,>->~z<J' 3v6 zoo izo Bo eC4~~~ de f//coo v'' "za • Q DoT e /60 11,9 J\ q < 2^/ \ ^ 22 ,511 Ga/v c, d~ cTQmes ~'fux C\"s~' <Ta .Fs-oi~ ~d C ~y a~~ o d o s ?~f aJ ~o C, _ C\ C5,-, ~P~hQ~-d Ho aid P F 4 l p ~Sc•h~z -S~>~ (z C) b, ,z ss 46 A-1--yet- ,Bern: e D/soc~ d s~o • z o Q /y¢//~~ ~ 80 ~ ~o p ~ ~ .Foh~ O cam aii- ~is6~6 217 C\ /zo h ~S.Y ~s ~ ~ c ~1 C h ~ / cz ro%' ~n Vl V. i46 > .T ~ ~ ~ ~Ge~-fi</o'e ~ 1 Osca~ v {1'm- e Don ~u9/¢s ■ 79 /'/e >`f 0 ~ ~ ° ~ia.~/a V ~ • fo 64 d ~s Q > ~Q.,~ c5f e~ce~- rjZa~~ 69 so~9o /i3 ZJa~/cbs y IQ y~ ~>2~ s¢o ~Yi~LO Peb <•~ah e~Q~a~. O 'vh ~ ~ ~~,e ~ ' ZJ/ffin~/~ ) • Goa©:ch7e ~6 5 00 ~9 s6 y T¢ h~ D ~Qy 63 v • q n ~ov✓"/es C p ode son 9 Bo ~ .S/ , o e¢~/f 0' /es ~ wV 7 a/✓eds ~ ~ CJ i 71 ,y I✓ Fi¢~C s F.N C'/, cd Q [~OmeS 43.Z _3ZJ S rP i.' V.. /OD /SZ, \ <33 G QI E//l1S ~/l S , V _ 40 ®/97 d~/O~ /moo SEE PA PAGE 45 r SEE PAGE 47 S PLAT BOOK COMMITTEE SALES COMMITTEE Contd. on page 61 Mr. James Ray Mrs. Charles Smith Mr. Jim Ruemmele Mrs. Gordon Mueller Mrs. Ross Pierson Mrs. Miles Casey Mr. and Mrs. Bob Phillips Mr. Robert Hater Mr. Al Franko Mrs. Guy Wilbur Mr. Don Matysik Mrs. Judy Ferguson Mr. and Mrs. Merton Vrieze Mrs. Joe Lohmeirer Mrs. Willard Johnson Mrs. Robert Gardner Mrs. Robert Hanson Mr. and Mrs. John Steele Mrs. Freida Fellinger Mrs. John Lavelle Mr. Robert Condon Mr. Leon Holle Mrs. John Glassbrenner Mr. Del Polzin Mr. Steve Thompson Mrs. Harlan Johnson Mr. La Verne Karastes