HomeMy WebLinkAbout191-1013-40-000
n y O K v n
o m w io
0 co
cn -P.
~ O O J ~ y
C7 N N !U O C NN r1'"j
cn ~ a ~ CO n ~ ~ _o
m m o n
fll
O CD (D i(D w < O r
U
01 ( O C'D O O
N N C O r
d (DD O !V
Z D ° _
f0 D m ~ ~
m
II~ C
rU f-. O O
!O (b C
(n
O o 0 r fn v
CD CD < ~ O a'
O O O O 'fit
jC~ fn fn !n O J
p. D N
Cp _ fD Q N
O ~ D) ~
= n: (o O
i
a N
D (D O
o' (`1
•
C
N (D
(D O
-U N
[ll (D
f~ i~ (O Q
O
j z CJ a (n
p ? p Z CD
in ~ A Z O
F a 0 O
o.
M
CD N A
m _ m
z
' 4,
p 7J
o z
3 m
N ~
(D A
N
COD
U O j 3
N
C -0
N (D
6 O 0
S < N O
CD d
O, (D Co
W
N _0
- y
p O
Q N
N~j C Jl VV
~ (D 7
Cn
N O N
co D
3 N
CD CD
CZ N O
N - `J
7
co
O v
m 5q A
O 0
CD M
OI~ r
N 0 c,
m f c v 0 con
(D 0' m 'B
C -
(n 2 2 va cwn ~ ~ a co L •
h m m ~ c _ c"~
(b0 Q N N N
CO p
Ul Q- Q (0 CD
co W O Ui c)
O J (D (D (D N N O .r
N a%
6) ~O _ (D O CD N11
N
N A O
CD O
I~ N
D z D o 2
CNC
D
Q
Z D ° r fn
(o a N
T v .
0 0
r
o
N i~ CD N Qo
d
(D cy
_ N O
O d
a
CL
z z
D o w°"J
M .
CD N N
i CD
N
C O
i~D d
13
''D N
} O A Z ID
N l~
M N
co
CD
CD z
z
F
m cr
O
CD
o v ID E
c < ii O
(D ~cl
O a' n
o'
3 ~ ~ cu
(D 0 7 z
QL) (n N ? C<D N O
- N CD N
N
N 7
N "6
D N D 6
N p
in v <
7 ~ O v
T ~ J
It A
(D N P
7 W ~
N N
(D (D
(D (D
A Q
(D cc
(D c
Ch 2
0 A
(D
Jy
< ft
0
O
O (D
O w
Parcel 191-1013-40-000 06/08/2006 03:56 PM
PAGE 1 OF 1
Alt. Parcel M 34.29.15.102C 191 - VILLAGE OF WILSON
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
TIMOTHY L & KELLY A RIVARD O - RIVARD, TIMOTHY L & KELLY A
2402 BONGEY DR #14
MENOMONIE WI 54751 Lj/
1/1
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 420 HWY 12
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
b<y
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 34 T29N R15W PT SE NE COM SW COR TH Block/Condo Bldg:
E 209 FT, N 184 FT TO S LN OF HWY 12, TH
WLY ALG HWY TO W LN, S 238 FT TO POB VIL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
WILSON EZ-UT-1390/01 7
K ~G161c~-~ 34-29N-15W `7 l
Notes:
Parcel History:
Date Doc # Vol/Page Type
- i/ 01/12/2001 636743 1575/167 QC
S/-7a-u~ ~ 01/12/2001 636742 1575/162 TI
D ! 10/25/1999 612640 1465/481 QC
5 ~ - 09/02/1999 609755 1454/113 M0QG1
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/31/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 10,000 76,600 86,600 NO
Totals for 2006:
General Property 1.000 10,000 76,600 86,600
Woodland 0.000 0 0
Totals for 2005:
General Property 1.000 7,200 76,600 83,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 191-1013-40-000 06/08/2006 04:02 PM
' PAGE 1 OF 1
Alt. Parcel 34.29.15.102C 191 -VILLAGE OF WILSON
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 - RIVARD, TIMOTHY L & KELLY A
TIMOTHY L & KELLY A RIVARD
2402 BONGEY DR #14
MENOMONIE WI 54751
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 420 HWY 12
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 34 T29N R15W PT SE NE COM SW COR TH Block/Condo Bldg:
E 209 FT, N 184 FT TO S LN OF HWY 12, TH
WLY ALG HWY TO W LN, S 238 FT TO POB VIL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
WILSON EZ-UT-1390/01 34-29N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/12/2001 636743 1575/167 QC
01/12/2001 636742 1575/162 TI
10/25/1999 612640 1465/481 QC
09/02/1999 609755 1454/113 mor
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/31/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 10,000 76,600 86,600 NO
Totals for 2006:
General Property 1.000 10,000 76,600 86,600
Woodland 0.000 0 0
Totals for 2005:
General Property 1.000 7,200 76,600 83,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
n(A O K m n " rw
~ ~ W (D f
•Y
O W G ~Ll
2 2 ^T SV
C) N N ~ ~ C = A CO e~ •
~
(p O O V Q. cQ (D
L2. Q Q co O j O A
W W N O O W
CO
O
O v w C<
A
'cl
p Q 6 (D C O O o
O O _ _ (D O O
7 Ul O O ^
C/ C O N
(D Z D O _
m D ~ a ~
c O O
<n o c
o rn m O r c
z O O O o
0 0 v
o 1 v
E cn cn (n m
Cl) (D o v
N L K
Q 2 v R~
(D = (D (T !V
p~ O
N O 3
O Q
O p~ m
3
Q -i
Q
o z -1
Z z
O
n D >
m O ro !o N
O
o cl) N N•
ro 0 i-0 m
c (D a
m
? O ? n
c: :t
M z O
IN. Q ~ O
C/) N a
W (D m
z
CL
1
o - z
o " m C
N
(D A
0
O N
O
(D
p n N D 3
C <
O S n'
T
~ ~ `G ~ N C
(D O ~ S ~ fl.
N ? (CD N O
N.
N (D w
i
(fin in
(D N (D "O
y
N N OG
y
(D N Cn
Q M-0
L
7 W ~
N N
O O
I
O ro
O Q N N
(n
`I
C
O
CD bq C~
d
Efl O w
O
CD (D
o v
APPLICATION FCR SA 1ITARY Fr; `iIT '
for
INSTALLATION OF A '-~:PTIC TANK
(Sec. 144.03, Wis. Scats.)
A. 0': Iv +'R OF PHCP`_L'RTY
Name Address (Street, City, Zip Code)
D. LCG ~ ICi 1y CF P K P TY ,,fH lq' SEPTIC T` 1a IS TC B" I145T .LL'?D
Che k 1, City 'fail kddress County
one: 2. ,LVillage
3. Town
C. IN`-TAI,L_„?, Give L -cense number held:
lilisconsin Restricted
Licensed Sewer
Plumber Services
blame Address
D. SP=FIC .TICNS OF S ±PTIC TA1•Y
Size in gallons: (check one)
1.-1, 000 Gal. 5. 4, 000 Gal .
2. 1,500 Gal. 6. _ 5,000 Gal.
3. _+2,000 Gal. 7. If over 5,000 gal., give capacity.
4. 3,000 Gal. _
Materials: 1.1-Prefab concrete 2. Poured concrete 3. Steel
71- TYPE CF CCCUPAi1CY
1. Single Family residence 3. ~C Commercial establishment
2.M1;ltiole family residence 4. Industrial establishment
F. APPRCiI1L.iTE NU?~~;~ OF P_'?,RSCNS S-~;_RVED DAILY
G. PET CXLATICiI f. T ,BADE 1, / Yes 2. No yDate v
By whom
(To be completed by County Clerk) /
Date a plication is filed and fee paid
Permit issued (date) Permit (dumber ~J
y County L A. Clerk
I
' Parcel 191-1013-40-000 03/20/2007 09:55 AM
PAGE 1 OF 1
Alt. Parcel 34.29.15.102C 191 -VILLAGE OF WILSON
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 - ENG, PHILIP MARVIN
PHILIP MARVIN ENG
420 HWY 12
WILSON WI 54027
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 420 HWY 12
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 34 T29N R1 5W PT SE NE COM SW COR TH Block/Condo Bldg:
E 209 FT, N 184 FT TO S LN OF HWY 12, TH
WILY ALG HWY TO W LN, S 238 FT TO POB VIL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
WILSON EZ-UT-1390/01 34-29N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/30/2006 837593 WD
04/27/2006 823685 SD
01/12/2001 636743 1575/167 QC
01/12/2001 636742 1575/162 TI
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/31/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 10,000 76,600 86,600 NO
Totals for 2007:
General Property 1.000 10,000 76,600 86,600
Woodland 0.000 0 0
Totals for 2006:
General Property 1.000 10,000 76,600 86,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• N
~cm Z~ . ca r/sa~
APPLICATION FOR SANITARY PaiMIT
for /
INSTALI.ATICN OF A ° 'PTIC TA Y
(Sec. 144.03, ':'S.s. Stats.)
Val, 7: / 30a -,,4 ST
A. O"4NFR OF PROPERTY
Name Address (Str et, City, Zip Code)
~Lt_2~ cZ 2.1 t• ~~=~1 ~ ~lt~.~~ iC=t`-d~ ~ ~x -~E,:I~--L:.' ~G~ 7
D . C JICN CF P?CPE'?TY H ,1 SEPTIC TANK IS R B INST '~LL aD
eck 1. City Mail ddress County
one: 2. Village ,
3. Town
C. IN`-TALL {2 Give L _cense number held:
Wisconsin Restricted
Licensed Sewer
Plumber 5ervices_~/1L~
)me Address
'a
Wt tv
wff
SPFCIFIC.=;TICNS OF SUTIC TAI•?Y
Size in r11,500 lons: (check one)
1. 000 Gal. 5. 4,000 Gal.
2. Gal. 6. _ 5,000 Gal.
3. 2,000 Gal. 7. If over 5,000 gal., give capacity.
4. _3, 000I,Gal .
MAterials: 1. X Prefab concrete 2. Poured concrete 3. Steel
TYPE CF OCCUP ,~IICY V
1. Sin-le Family residence 3. ' Commercial establishment
2.~ Ml..,ltiple family residence 4. Industrial establishment
F. APPRCXI,1AT7' NUMB 4:.. OF P_i,tSONS S ;RVH,D DAILY l
G. P3RCCLATICPd TEH MADE 1.~ Yes 2. No Date ;711.5 IZO
(To be completed by County C erk)
Date a placation is filed and ee paid fv
Permit issued (date) PermitrNumber, < %
County, s~~ Clerk`'
µ Percolation 'ate Tinimum Absorption Area in Square Feet per Bedroom
Minutes aeouired Normal ?,lith Tith With Both
For Ti1ater to F=ill Plumbing Garbage Automatic Grinder and
One Inch Fixtures Grinder Waster Automatic
'ovasher
2 50 65 75 85
3 60 75 85 100
4 70 85 95 115
5 75 90 105 125
5 - 10 100 120 135 165
10 - 15 115 140 160 190
15 - 30 150 180 205 250
30 - 45 180 215 245 300
45 - 60 200 240 ?75 330
60 - 90 240 290 325 400
ti!1 UJ Cn
rk3 .3
(D r6
cl. F6
° °a i µ o w c' H tz~ 0y7 p H H U Cy 7 I
w 's r w rn ° z r ~ C~7 G] U CHID o ^ ~~1
v o m o~ tfr * CJ H b ti
V) CD
µ p e+ rm. - - - - - - - - - H CA '=J 0
f s w r N In, d 7G'
o o w m
0. 0 CA m t'. (D v 'r.1 yry '
0 10+
cL" F+ m b GO W H F~• +H~
5+
o o _ o CD
rn o x tE'~~ ~c7
° o ccr \ O
W
14 t~
0 84 Fu
`Q° a z
n O t~ m O
o Cr ty
m~ hr (D (z O M y C''
O O ~
~o ~p B o H • c+ ~ ~ J r~iCO C~17
c'+' A>' + r(+D~ n 'TJ id
t c co H 'OTJ x O
-0 En L4 z
o a x zaaz z
o P. ° O ~ ~ N G7 rC C tylJ
- - - - - M m.. o o ro~A
• v
x ro t~+ ~Of ' d cD C~ 'd , O H H 07J
D y (D W a
yro 9 t xQ H C•7 • i t
11+
i°\ "l I O
ci- to C N ~Ni H O F f cF F m O to ril 1-3
pa co O H
:0 z
8 x H CrJ z
~ s y tr'i A w z C d
y C+ FI- 0 F4 <i
b o o \ << m x
a H W N¢Q+ Q' J V] co a
08-3 El)
-1 2 C+ C+
y N ° 0 m~ H bc7 C7 co
V1 P. o O (d \ co H H LTJ
O H O z Cl
W
_y y H
to r' rJ 0 ~ m H O cn
C+ 0 114 ~t
y ~3
^ W W z x
Y r H b H (.7 & L' O a 1 Or Co
al -0 ~3 1-4
r N goo F +q H
m to a~ O E 4 N rn
_ rM ¢ ro
W CO r F-J
O W m t~J wn
°o 0 O
co 0 so
C+. Cf. 4 A
0 C+ Pi &
-c ; ro
- - - - - - - - - - - -
*0 F-4 0 11
r s y W C a
°O a t y
rn
a x o cn Im I \
1-4 0 7' \
A. y O
I
v
m a •0 _o
0 0 0
L O X -a L 'L
3 41 +r m M +1 3 a)
O Ln ^ V) 4- 0 V) a ut
4- O ^ 0 u v O 4- m 0 C a 4-
•0 c c X m ^-Cv 0 m m 0 a) 0) .t O 0 O
V) 0 0 41 a) t 0 u 41 c E O c I- a) ut
0 C-C V) -0 0 > c E L t t ut ^ 0 0
.c ^ a m 0 m 3 0 0 E c ^ m 0 0 ut c)
41 m 0 0 3^ {J L. C L" L 0 m > m +J
L> L in ^ O (A 0) N O -04- m 0 E m 0 0 L O -a m L- u m
O^ 3 m 0 ^ 3 0 ^ 41 - m 3 +J +J to 3 3 u - L 0 L.
id m 4-1 L > U aj ^ JJ 0 -0 o 3 V) O L Q1 a C t
m 0) 0.- m m 41 -C 4- U 0 0 .L 0 3 0 C 0 M - 4 C
C 0 L to m 4- 0 t O N +t -0 - O C .C W
m a 0 O 0 E 0 .a +r L Qt to 3 a O C 0 O +1 L L 0
Vf C C O +t 0 C C ^ m m 4- ^ w O C O^ m
4- -0 U 4j -0 ^ to m > m 0 0 E 0- 4J 1-t L 4- 0 4-J -
O L c C 3 0^ c^ O^ c E a) m 0 L U 0 > L O c
O 0 m m m O O ^ -o v+ r to -C s O 0 0> m O u O
m 4- to to L- s U L- 0 0 O IA u of 4- 41 N O ^ L t L
0 O N 0 0 0 1-+ L 0 4- ^ .0 t 0 c m m 0) n 0
L. t a 0 ^ m a a) +J 4- 0 J-+ E^ L. C^ C to > a m
m +J x ut ^"0 a m-0 0 - m 0 3 0 L
0 L 4- N m C 3 C u 0^ L a) C > L u L 0 L 0 O
t 0 0 0 O m m L. 4- - -0 U 4J 4J (n -C U
L to u t 4- u a ^ -C F- 0 a) m m a) c c 0 L-
41 _ 4+ u .C C O O 0 (A L- V1 rn 4- s 4J N U - 0 4J 0
+1 u 4- a) 0 Vt 0 C O +1 c w 0 4- > 3 0
c 4- +J 4- a 3 .C t '0 m Vt +.t ^ 0 O X 0 O C
o c 0 0 to ^ I- O (U 0 m m (u ^ >-%D O 4-J u +0 -0 m 0
0 M 0 - t .C 3> dd ^ 41 0 3 4) 0 N m m E^ L
G E to L > t 'L U 0 a\ 41 C-C ~ a C 3
L O_ 0 E a) m u 0 c 0 4- E +t +j a) to c to c u
L .C 3 L -0 m a 4- 0 -C 0 (U a C E m m E 0 W-
41 •tn U E m 0) 0 O - F- L L c 4).- _0 3 Vt L L +1 m c
0 to C - 3 > L- N m (D m u E C) C m c U u -
E> c •C 0 0 a C ^ +j L X m m 0 0 c c •L-
M E a m Vt L 0 o a ^ a) +1 m O
- O O E O 0 m L- 0 0 0 3 L- m en c N 0 L C 41 ~
L 3 L- E 0 7 0 0 0 m 0^ > O y X 4-+ _
0 m L- L- 0 0 3 E > C O C L- -0 L N^
c s +•t - 0 0^ 3 MD 0.- t 0 0 v+ 3 m ` E m 0
0 4J c 0 O •O > a-- to 0 E E m c t rn ^ to v+ >
L - U > O 3 >u -0 0 a L 0 L. w a O 0 L 0 3 m
3 N 4J O m L 41 0 ^ O 0 L- O E 0 N E 0 C> 0 L-
0 U CI.^ L 0 of O iJ t ^ L 0 L. O O L a 0 0 M -C 0> 0
0 t m a a) V) 0 c 3 a u 0 -v 4- U M .C ^ C O ^ O c
u U+1 a 41 0L 4- O a 0 > 41 a)
O C C L- m L U +.t L. 0 a) L- 0 4- -0 c C 41 L L. L. {d ' r- L
L O m c 3 C^ M 0 L- t o ^ .C O a) C 0 0 0 0 0>-
^
a v s m to m-C m ^ a) O E Ln a > a +-t c m m
N V1 L 3 L 4- u c m '0 C 0 >m O m
3 L 0
+1 of m^ N to m +1 m ..C -0 0 0 L- ut 3 C 4) L m 3 m of >
N m 0 a) a O > m U tn c t 0 O
3 L
0 m L- ut 3 m 0 3 0 0 c a s
O L. w Vf m 0
3 a 0 0 m u Y C +J +J O a0 m`
4J -C OC U 0 0 3 0 0 0 u 0 to ^ a t to 0 U to m m a 0 L.
~
O -T 0 '3 0 t O L. 1-t L 0 0 0 0) E O a E 3 d a 0 0
m r- L 3 m 0 0 C > m c 0 _ O m of
4- -C V 0.- n c V) m C M a.+ 0 0 C 4- O 1-
41 V) (n •3 a L- L V) 0 0 L- L- 0 m v) -0 0 O L -0 O ^ 0
41 >
O + L ut 0 0 > +0+
O) to 4- 0 C-o O O E ..0 0- w; N vii +L
O O m m O O 0 >4- M E" 0 L- m 0^ 0 t C m^ m
U t C 0 t ^ m - 0 L m O .C (A ^ ^ +t m V) t 4J +W L L 3
L - L ^ a L C L^ O V) a+ 1-t 0 0 0 0 m -c m u m 0) L
0 ^ m m 0 O - a O 0 m O 0 C +1 0> 3 to c 0 0 0 0 4-
a m L- L +1 4- 3" 4J L V) ^ 0 3 m t 4) L. to 0 +J O
u '0 +i +d VI 4- 1-+ L 0 > C L. 0 41 4- N 0 7 0 t m
0 O L- m m m +.t L. C O 0) V) O IJ t N L 0 U 3 to
L 4- a) 0 0- 3 0 0 -a E 0 0) L C 41 ^ 0 m 0 0
L O O ^ a +1 0 L- C c m 0 0 0 0 N 0 4) 0 0^ L
0 0 3 m^ O C to 0) O .C U.- 0 E C 4- m E > m u
> +J 4- E .C 4- L- 3 0 E 0 - E a) 3 0 M 3 L- M -C 0 O 3 c O c c~
O41 0 O -C L to •C O 0 of 3 3 U L. +J 0
0 •a 4J L t L Ai c C 3 ^ -C 4- 0 'D c 3 N 01 C .L m 4-
0 41 E - m 0 O O m 0 c ut U O> O c a) to L c -v 3 •xi
L- 0 3 O O •O U L- .C 4- dJ +J c 0 3 0 +1 m 3 m O L- 0
t 0 L to m 3 N O C E +.i Ln Vt -0 4J v m x 0 u ^ a 0 0 •C tn'
m e v- 0 w L- u o c c m^ m m a L. E U ^ to F-
a v 4- .a V) 'o c 3 to 0 u C 0 s x m 4- E O ut O - (n 0 0 m c
41 0 C C^ O 0 0.- O C V) 0 E a L C C 4- 0 U L 3 m
N 0 m m ^ u^ L O to 0 .C of L 0 0-0 O +1 0 41 ^ C s
m N - 0) ^ 0 ^ 01 M C ^ m L- u 0 -C to -0 w 0 m -0 0 0 4- -0 Aj
0 to Ln •L C m a C Z m 3 C 3 C U L. 0 +J L- 3 .c C L L .C 0 0
0 0 -C 4- ^ 0 O m o .L M C C 3 +j L m O O 0 LA 0
0 to • -0 a,, to 4- c m to m 3 -C O O F- ^ 4- 0 u 4- ut 3 L-
41 VI 0 0 m - V) C 0 V) 0 1aa c O -a- 0 to 0 rn 0 Q
M 0 to E 0 4) - m m 41 A a m E^ X u a) 0 VI 0 L C t 0 t
a O 3- rn E s W 4- v 0 3 - a) m i L ^ L t^> 4.1 u
0 0 t+- .L 0 4) Vf 0 0 0 0 0 C 0 m 0 •O L- w 3^ a 0 m 0 0 3 0^ C
L L O t (A t L- 41 u m 0 V1 +-t O M O Cl L C 0 v ^
O a 4- O 0 O V) 0 V) (n m C L- 4- t L. c L -W x (0
-a C O O C 0 t L- to 0 a L a L- 0 0 -0 0 0 0 L- E 4- X 3 t
0 0 0 C m C 0 0 3 of C 0 0 C •O > C -C -C 0 4- 4- 4) O ut
L -C c 0 F- 4- ^ - 0 c ¢ O a O m ^ 3 C - c L (A
t
O O O-C 0 c 0 ut m 0 to m w O C r 0 0 m 0 m to 0
t m 0) -C V1 O L- 0 3 + -C m 3 0 41 " > > 0 3 aJ - 0 ut ~
0) 4- L +r 3 d-t 0 iJ O 4-1 L +1 - 4- U O 0 0 4-+ 0 E L- = ^ m
4- O 0 m 0 m- C -0 to 0 m m O c c o^^ m-0 E c u c 0 3 m U`
Cr- 0 O m 0 rn 0 +d 0 N - L O >
O
C3 -C
-a m > L L- 0 L VI ^ C 0 -c m 3 O L L 11 0 L L 3 4- 0 L- O
0 iJ to a O 3 > L u 41 3 0 u 0 c^ 0 0 u 0 t 41 > ~ O N c
CL a c 0 E 0 m 3 0 L- O L- M4- +.t 0
0 0 L- 0 s m L- 0 0 3 3 L- 4.. 4- 0 0 0 0 0 C m m m -C L- 0 3 c c-C c C
-0 u a. oc to rn Vt -C to v a - O _a a 'O L a•- 3 3 u -0 m m 0 3 -
N M
S~f~ 1969 '
,ter ~
NA*Sf' OF BUSINESS ' .5
LOCATION
7i% t v~</' r r l / t! r r
str-e or highway city-or township county
OWNER Mailing address
4
ARCHITECT OR ENGINEER Address
PLUSBER Address
--«r` .
1. Chack appropriate building wage(s) and fill in the information requested opposite
each usage listed:
Existing building N New building _ Addition
if addition to existing building attach detailed veto for each.
( ) Restaurant or dining room . . . . Seating oap:,city (10 sq•ft./parson)
'•L
Motel ( ) Hotol ( ) Cottages Number of units: Ra~alar HrnisokeePin,
. r 2 persons/unit
J \ 4 persons/unit ~ TOTAL MW3ER OF UNITS
liar or cocktr.il lounge . . . . . Seatins; capacity (10 rq.ft./person)
NurDL, g or retix-'imcrst home Nunber of beds
Mobilo h=o park . . . • Numbor of units - dapendcnt
- ncndpondcnt
Service otatian t;uebor of oars served (6zi.ay)
t~ ( ) School . Nv_,)cr of olannroons psals servod Yon No She:rora provided Yes No
Pactovy or of ioa building . . . t3u:::bcr of persons (total all shifts)
r
Residmoe • . . • • . .
2fia:abar of borlrocns
Othor - apocify L Lt .A _o ? v L, ~~r; ~1~
2. Indicate rh:~-`.`a+,r or not r:'jo folle:ing faoilitios are corn^ioted: rood waste €rind;:r . . . Yea No
DiGhT4,51102 . . . . . . Yes IIo
Automatic elothos maL.hor Yev 210
3. Fill in tho for tl. fol1o.s41g as indiaatcd:
~ en .
Soptio tm% c p^oity pl&nnod Not.n.l s;,ptic tarp': capacity riquired (0 ,
50,a inorearo for rim or :..'.i Total reptio ts,n% of pr oity rcqui,: eft
Poroolatinn taut roLults - ATWCH
Soc:lx a t. onoh bottom area pl n d rl /6 3 J~ width 5 s linear Poat dop th
SoCPS.;o pit plannod outnido di4 :titer , depth bolow inlot a depth
Soopsga trz.aali bottu:a €r;za raquirad width linear foot
o`pegs pit raquired_L- , outsido dinnoter , depth brlc,r inlot
o F
Si->t.Hture~ Si"ATE BOARD OF HEALTH, PLUMBING DIVISION
P. 0. Box 309, Madison, Wisconsin 53701
Da~e Date p ~~`y_t~f A wp~ B
~F.".i?1 TY{E I?iFL"lLAf1G?i Fns- CITY, Vlt-
11r;;~
G~i tt`::11t REQUliu:i:;tii15,