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Parcel 181-1009-40-000 03/20/2007 08:53 AM
PAGE 1 OF 1
Alt. Parcel 36.31.19.448 181 - VILLAGE OF SOMERSET
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 - J R B ASSOCIATES INC
J R B ASSOCIATES INC
PO BOX 67
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description * 100 CHURCH HILL ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.270 Plat: N/A-NOT AVAILABLE
SEC 36 T31 N R1 9W PT OL 44 COM NW COR Block/Condo Bldg:
SW1/4 SEC 36 TH S 1790' TO INT HWYS 35 &
64; TH NELY ON CEN LN HWY 35. 71.1'N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
125' TO POB; TH N 204.2' TH S 88 DEG E 36-31 N-1 9W
350' TH S 111' TO NLY LN HWY 64; TH SWLY
ON SD N LN TO POB VIL SOMERSET
I
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1119/564
07/23/1997 828/507
07/23/1997 781/524
07/23/1997 778/625
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2006
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 1.270 220,100 172,900 393,000 NO
Totals for 2007:
General Property 1.270 220,100 172,900 393,000
Woodland 0.000 0 0
Totals for 2006:
General Property 1.270 220,100 172,900 393,000
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 Uconsin State
APPLICATION FOR PERMIT Division of Health
3~.~l / • Vq 8 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
,.r ij`
B. LOCATION OF PROPERTY WHERE SEPTIC TANK IS TO BE INSTALLED
Check 1. City Mail address County
one: 2. Village
3. _ Town
Give license number held:
C. INSTALLER Wisconsin Restricted
Licensed Sewer
Plumber Services S
Name Address
D. SPECIFICATIONS OF SEPTIC TANK NEW TANK REPLACEMENT
Size in gallons: Check one
1. 500 gal. 4. 1,500 gal. 7. 4,000 gal.
2. _ 750 gal. 5. : 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. Poured concrete 3. Steel
E. TYPE OF OCCUPANCY
1. _ Single family residence 3. Commercial establishment 5. Other
2. Multiple family residence 4. Industrial establishment
F. APPROXIMATE NUMBER OF PERSONS SERVED DAILY
G. PERCOLATION TEST MADE 1. Yes 2. No Date
By whom -71
(To be completed by County Clerk)
Date application is filed and fee,paid C"
Permit issued (date) Permit Number,;°"_2 t
I /
County. Clerk.'
Note: The application cannot be considered'for filing until all of the above questions are
answered and the fee plid. County Clerk will forward application, the fee of $1.00,
and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and
money orders should be made payable to the Division of Health.
Plb 60• 199
NAME?qjF _BIiSINESS
LOCATION
street or highway:; city or township county
OWNER Mailing address
ARCHITECT OR ENGINEER Address
PL73MBER Address
1. Check appropriate building usages) and fill in the information requested opposite
each usage listed:
Existing building _ New building_ _ Addition
If addition to existing building attach detailed memo for each.
(~~)r Restaurant or dining room . . . . Seating capacity (10 sq.ft./parson)
Motel Hotel Cottsges Number of units: Rods lar Housekeeping `ti ~r r S I t ' r
2 persons/unit
4 persons/unit TOTAL NUMBER OF UNITS
Bar or cocktail lounge . . . . . Seating capacity (10 sq.ft./parson)
Nursing or retirement home Number of beds
Mobile home park . . . . . Number of units - dependent
- nondopendent
Service station . . . . . . . . Number of cars served (daily)
School . Number of classrooms Meals served Yes- NoShowers provided Yes_ No
Factory or office building . . . Number of persons (total all shifts)
Residence Number of bedrooms
O other - specify
2. Indicate whether or not the following facilities are connected: Food waste grinder . . . Yes No
Dishwasher . . . . . Yes-- No
Automatic clothes washer Yes No~i
3. Fill in the appropriate information for the following as indicated: ~j
•t1' //l
Septic tank capacity planned` /fCi ✓ Normal septic tank capacity required
50% increase for FWG or AW Total septic tank capacity required
percolation test results - ATTACH PEP.COLATIOH TEST RWRT SM%?
Seepage trench bottom area plan^ d , width s , linear feet depth 7 "o/
Seepage pit planned ry- , !outside diameter , depth below inlet depth
Seepage trench bottom area required 06'-~ width linear feet
Seepage pit required ~Ca outsido diameter , depth below inlet
Signature of e~son completing form: STATE BOARD OF HEALTH, PLUJIBING DIVISION
/l P. 0. Box0 Padiso Wiscygnsi 53701 •
Address:;' Approved:gtt
Date Date MAY 2 3r
THIS A»o,~ inL li ° J" 1F1G ME R NE nr '
E~ THE C'."Y. VIL-
IX i•.?T
LADE, T06%i; H.' OR COU:~1'i fiE: U-A1lONS
~R PER.+iIT R~QUi E'r, ~i1TS