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Parcel 042-1055-80-000 01/18/2007 02:32 PM
PAGE 1 OF 1
Alt. Parcel 20.29.18.308B 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
O - JOHNSON, JOYCE A TR
JOYCE A TR JOHNSON
854 110TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 854 110TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R18W 2 A S 16 RDS OF E 20 Block/Condo Bldg:
RDS OF SE NE
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/15/2006 838881 QC
09/10/2001 656222 1716/82 TI
01/13/1971 303523 468/299 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
149438 174,600
Valuations: Last Changed: 07/11/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 37,500 89,900 127,400 NO
Totals for 2006:
General Property 2.000 37,500 89,900 127,400
Woodland 0.000 0 0
Totals for 2005:
General Property 2.000 37,500 89,900 127,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 110
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
Wisconsin Deprrtmont of Health rid Sooiul St. vices
Plb. #67 3/70 Division of Neaith
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. O'MNER OF _ PROP: R T`Y
Name Address (street, city, zip Code)
t_
Be LOCATION OF PROPERTY W f✓RE SYST77M WILL BE CONSTRUCTED ALTF.RF.D OR EXTE`T)ED COUNTY
Check One:
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP i l
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEKENT ADDITION i
MATERIALS; Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
-Check One: One or Two Family Residence Commercial Industrial Other
Number of Persons to be Accommodated Number of Bedrooms Sp ecify)
7
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dish rasher YES NO Automatic Potato Peeler YES NO
Other (Specify)
G. MASTER PLUMBER l-.AKLNG INSTALLATION
Name: Address: License Number:
Kra .1
Signaturo of Applicant: MP RSW
Address=
H. (To be Completed by Issuing Agent)
Date of Application J / Fee Paid
Permit Issuad (date) 7 Permit Number
Agent (Name) For Town, Village, City,"County, etc.
(Specify)
Note: The application cannot us considered for filing until all of the above questions are ans-mered and the
fee paid. Agents will for-.,.-ard application, the fee of ;LOOT for each aeptie tank and the third copy
of the permit (canary` to th9 Division of Health. Checks and money on:ers should be made payable to
the Division of Heait),,
Do rot write in 3race below - FOR DEPART.", tii' US$ ONLY
n ~
1 1. DATE RECEIVED /xI ACCEPTED BY
Initials ~J
( ) (Pate) (Sze Corras.)
FEE RECEIVED M r VALID. No. r ! PERMIT NO.
(Yes or No)
REVIE''IsD BY APPROVED DATE
(Initials)
(Yes or No)
CCYaL 71- O.7i%R SIDE,
_ I
.a
• SEPTIC TANK PEFMYIT NO.
f
R K P 0 P T O N S C: L P Z R C O L A T O N T V S T
A N D S O I L B 0 P. I N G S
TO
DIVISION OF HEALTH - PLU-13111G S=TI&A
P.O.Box 309, h'wdison, Wis. 53701
Pursuant to H 62.20, Wis. Administrativs Code
P 8 R C 0 L A T I 0 N T T S T
Test Depth Cha.raotor of Soil Hours Water Test Tiro Drop in katar Level Inches Minutes
Number Inohas Thizimess in Inches Since Hole in Hole Interval Serond to Next to Last To Fali
ist Wotted Qvarni-ht in Minutt~s Last Period 1-°-st Period Perioei Cn^- Tn--
Example
P - 0 3611 Too Soil 1011 Clay 26" 25 Yes or No 30 1 2 112 1 2 60
RECORD DATA FRCM MDNDK M 0' 3 TEST HOLES
Compute size of absorption aria in accord with H 62.20 Wis. Administrative Code.
S 0 1 L B 0 R I N G S- :finimm 3611 Belo Pro »ee Absor°ation S,yst'a
Boring Total Depth De th to Cround '.,a-ter D3oth to Badroc„
Number Inches Observed Estir7itad Observed Estim%ted Character of Soil with Thio'_tness in Inches
Example
B - 0 7211 72" Black To Soii 12" Clay i8'';S°nd 18"; Gravel 2411
1
RECO';LT1 DATA FROM MIND UM 07 3 30RS HOL 3
TYPE OF OCCUPANCY:
RESID_;2ICEs Number of Bmdroc is ? OTHERS (Specify) Number of Persons
600D HASTE GRINDER. Yes No D1st-rashart Yes No Au:ozz,.tic Cloths Washer: Yes No
FFUJF"N? DISPOSAL SYSM: NEW EXTENSION ADDITION REPLAC=E iEDNT
Tile Size .f No.Lin.Fset Trench Width - ' Depth N•=ber of Lines
Seepa;9 Bed: Length Width Depth Tile Size No.. Lines
Seepage Pits Inside Ditiaar i,iquid Depth ,
I, the undersigned, hereby certify that the peroolation tests reported on this fos~c were mada by me or und3r my super-
vision in accord with the proceduras and method spoaified in Chaptar H 62.20 (13), ;iiscensin Ad:xinistrativ% Coda, a.;d
f tint trij data recorded and location Of test hole3 are aorract to the bast of my k.mcwil ad e and belief.
NX%M TITLE
(Type or Print)
REGISTRATION Y0, or MASTER ?LL,13SR LICJ sl NO.
ADDRESS
i
DA'E i SIGNATURi