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Parcel 016-1049-50-000 03/19/2007 04:10 PM
PAGE 1 OF 1
Alt. Parcel 22.30.15.35513 016 - TOWN OF GLENWOOD
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 - DKVJ LLC
DKVJ LLC
1462A HWY 128
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es):" = Primary y
Type Dist # Description ` 1462 HWY 128
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 22 T30N R1 5W 1A OF LAND SE NW COM Block/Condo Bldg: J y
320'N & 50'W OF SE CORNER SE1/4 NW1/4
TH NWLY 13.5 RODS, MOL, TH NLY 11 RODS, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
MOL, TH ELY 12 RODS MOL, TO E LN SE1/4 22-30N-15W
NW1/4 TH SLY 14 RODS MOL TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
09/20/2004 774762 2659/170 LC
07/23/1997 879/569
07/23/1997 754/354
07/23/1997 668/381
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 1.000 9,000 135,000 144,000 NO
Totals for 2007:
General Property 1.000 9,000 135,000 144,000
Woodland 0.000 0 0
Totals for 2006:
General Property 1.000 9,000 135,000 144,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form Plb 67 Wisconsin State
APPLICATION FOR PERMIT Division of Health
for
PURCHASE OR INSTALLATION OF A SEPTIC TANK
(Sec. 144.03, Wis. Stats.)
A. OWNER OF PROPERTY Type or use BLACK ink.
Name Address Street, City, Zip Code
i
B. LOCATION OF PROPERTY WHERE SEPTIC TANK IS TO BE INSTALLED
Check 1. _ City Mail address ~(Jd- ►Ay Y.~/ County
one: 2. Village
< <3. Town ~ ( & ~ , a;` z t
Give license number held:
C. INSTALLER Wisconsin Restricted
Licensed _ Sewer
Plumber A. Services
Name Address
~y c1 i
D. SPECIFICATIONS OF SEPTIC TANK NEW TANK REP CEMENT
Size in gallons: Check one
1. 500 gal. 4._ 1)500 gal. 7. 4,000 gal.
2. 750 gal. 5. L4e 2,000 gal. 8. - 5,000 gal
3. 1,000 gal. 6. 3,000 gal. 9. Imo`-over 5,000 gal. give capacity
Materials: 1. Prefab concrete 2. i Poured concrete 3• Steel
E. TYPE OF OCCUPANCY
1. 'Single family residence 3. Commercial establishment S. Other
2. Multiple family residence 4. Industrial establishment
F. APPROXIMATE NUMBER OF PERSONS SERVED DAILY
c
G. PERCOLATION TEST MADE 1. Yes 2. No Date
d
By whom . "t
(To be completed by County Clerk)
Date application is filed and fee aid
Permit issued (date) Permit Number
e
County( i Clerk '
Note: The application cannot be consideYed for filing until all of the Above questions are
answered and the fee paid. County,/Clerk will forward application, the fee of $1.00,
and Copy (b) of the Permit (yelloof copy) to the Division of Health. Checks and
money orders should be made payable to the Division of Health.
PV) 6 0 NAME Or BUSINESS
LOCATION
sire t or hi.)gt .;ay city or to-.ns.hip county 1 -
OWNER J Mailing address Jr
J
ARCHI`i'EC1 OR ENGINEER Address
Pumni2 ; ~L ~ ' ~n, i/; ~ ~ ~(=5 Address
1. ,T,tieck appropriate building usage(s) and fill in the information requested opposite
each usage listed:
ci c,7
a?xisting building `..r New h:zilding_ Addition
0 If addition to existing building attach detailed memo for each.
Rastaura.nt or dining room . . . . Seating capacity (10 sq.ft./parson)
s C~ r.7 -
d ) hotel ( ) Hotel ( ) Cott-,. es Nur:bcr of units; Rcc~ulrr Houehco iU
a 2 poi sons/unit M
4 persons/wiiv _ TOTAL h'UJi•BER OF UNITS
(1'>) B&r or coc4-i:ail lounge . . . . . Seating oapvoity (10 Pq.ft./person) r- ' r, !r y s
( ) Nuraing or rotironont homo Number of bode ~9-
( ) 11obilo hoar p--Ac . . . . . . . . Number of units - dopcndr~nt
- nondopendent
( ) Scpvloo sfFr ion . . . . . . . . Ntzr~cr of waro served (daily)
( ) School Number of olarsroc~s Mealn served Yes- No~ Shone:-- providod Yes_ No__
( ) Paotor or offices building . . . Nv Scr of porsons (total all :shifts)
O Nesid,inoe . . . . . . . . . . . Nu~bcr of bodroc-is <<~.
( ) athor - cpooify
2. Indieato wlDth;r or not th,~ follo;+inZ facilities are connected: Food raste grinder . . . Yes No
Dis}rraahor . . . . . . . YesNo,-.y....~
Autom9 tic elothea i:a~"hor Yes ' No
3. Fill izi tho nppropriatc :rfo.:~,0,on for th* folluuin, as indicated:
Septic tarl% cApa city ln_nnodf^
F _ Normal sortie tan,- capacity roquirod
5~ i.icraszo for YIEG or AU TotAl scp i.e tnn? capacity requ9drad t.%11
Percolation tort xeaults - ATYR,'11 P7,P OL4TTON TL'ST f 7P-3.rO SK >S
~.,C
SruopF!,&e tronoh bottom area pl ~nnid i '/"width linear foet J•°, , depth 4 * l+f
Seepage pit plannod , outside di oter depth bole- inlet depth - t ` Y
Se€.cago trench battc2 tray r quircd width 1'near foot
Seepage, pit required ~ v tsidc di<;roater depth bolos inlet ~ m
Sign,ature of person co nlpletinb f.orcn: STATE BOARD OF HEALTII, PLUMBING DIVISION
P. 0. Box 309, P adi~soyn,,j JWisconsin 53701
Addr. e s: 7 'M f . _ _ Approved: n
Date Date
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M2. DonAd K. Kinyo,,--.
Nadi son, Winuensin
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Secti.cA of Plumbing & Relw e l Sercicc.
Residence
Willits ,'xre,_.ch ~za~l.~.rz1 Tavern & I....icjer;c.e
;ay. 128, Glenwood Township, Wis :ons:.n
S,_. Croix County
in answnr to your O!. uCT)tetIlbE.r 7. 1969, ;ru{.1 v. M +::.iC.t.i:,.F?=C
the gY'nm that uos requested and answer to your q: _ ..7 tins .
Mr. Rn )..d C. .tbrber, St. Croix County Zoning A f:ini tfir to y Af
obtained the info:rmat mil by visiting An property in qvesLion,
if there are any further questions, please fee free to • vT n { U....
sinr'Fri; ) ,
Ben TAkIa
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i'HIS APP '':A(, ~-S fA~r;D ON .i`fATE
l F.72 .ra'rs AND z?G k, . ,'l U E
i ' ,
APPLICATION FOR SOITARY FF'cMIT
for
INSTALLATICN CF A `'"BIOTIC T.q?
(Slec. 144,03, 'is. Stats.)
4
A. 9'Z 7,4i CF PaCP_TR,TY
Name w r Address treet, City, Zip Code) {
B. i~01C ~TICN CF P;? -,,~-~TY S:.PTIC T_ NY IS TC BT, INS`.''.LL_+D
Check 1. City Mail %ddress County
one: 2, _Village
3 . _7T own C. IM,TALLT:t Give L4_cense number held:
Wisconsin Restricted
Licensed _ Sewer
Plumber Services
Name Address -
D. SP'=CIFIC:OF S'~`TIC TA1,7.
Size in gallons: (check one) p
1. _1, 1,000 Gal. 5. _ 4,000 Gal.
2. 1,500 Gal, 6. 5,000 Gal,
7, If over 5,000 gal,, give caracity,
3, 23000 Gal,
4. 000 Gal.
M:Aterials: i./rPrefab concrete 2. Poured concrete 3. Steel
TYPE OF OCCUPANCY
1. Sin=,le Family residence 3. Commercial establishment
2. fairily residence 4. Industrial establishment
F. Ar PRCATi:iT, 1.U?-irk ~i CF P"_iSC'NU LVED UAILY I~L._?
G. PJ` UATIC v` T sCT iAD" 1. Y, Yes 2, No Date f' 1
By whom
i
t
k
(To be completed by County Clerk)
Date a -nlicr.tion is filed and fie nwid
t
Permit i„su d ((.'tate) v , Permit 11Lmiber~t.:%
County