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to <br /> DEPARTMENT OF HEALTH AND SOCIAL SERVICES,DIVISION OF HEALTH <br /> C (Pursuant to H 65.06.Wisconsin Adminis«etHe Code) <br /> NAME OF SUBDIVISION _ <br /> CITY <br /> • <br /> VILLAGE �f+.��,,��,�EE��' 1,� �} <br /> LCCATION OF SUBDIVISION: TOWN �_OF S4:dTr_COUNTY $y�VQ7 SECTION—j-; OWN 40 N: RANGE�LW <br /> (Check Obe) <br /> NAME OF OWNER P OPA LV 600'e'- <br /> ADDRESS %qSZ7 �•T H VR .S ST ?O <br /> (N umber &S tree0 f Ptuel IS,...I (Zip Cope) <br /> NAME OF SUBDIVIDER <br /> A DOR ESS <br /> (Number d SvaJ (Fleec) _13baI �(Zip Code) <br /> SUBDIVISION WATER SUPPLY FROM: PUBLIC WATER SUPPLY PRIVATE WELLS <br /> ), 3 2 <br /> SUBDIVISION DATA: AREA IN ACRES NUMBER OF LOTS MINIMUM LOTAREA•S UAREFEET <br /> DISTANCE TO NEAREST NAVIGABLE SURFACE WATER hsEy kat FEET.(IF (THIN R MILE) <br /> NAME OF LAKE OR STREAM <br /> DATES OBSERVATIONS MAKE: SOIL BORINGS o` /9S PERCOLATION TESTS <br /> SOIL BORING TESTS <br /> TlST TOE+I Of liw Ol+i.iO C+OVgO werfe eGnIs C.. AcTae OP X^c"SOIL LATEIE Ve Tn in:CKn S51+INeef2 <br /> nV�ele eC�l3 OISi PVIO ESTuerFO-:GwlST <br /> e 74 L) 0,. 1s 4-16` 6nfS 144- 74 " INASJ c <br /> e- I7 pp <br /> e- I Foaly& Leo. Vee r �b DE We '�' O SF L w CORAPer <br /> e• <br /> e <br /> e- <br /> e- I <br /> e- <br /> e- <br /> e- <br /> e- <br /> e- <br /> e- <br /> e- <br /> a- <br /> a- <br /> e_ I <br /> e- <br /> e- <br /> e- <br /> e- <br /> e- <br /> e- <br /> e• � <br /> NOTE: 119,30-ACE 13 INADEQUATE TO Ii1,EPORT ALL SOIL BORINGS,USE AOOITIONAL FORMS. -Ov" <br />