Laserfiche WebLink
i �O A <br /> to <br /> DEPARTMENT OF HEALTH AND SOCIAL SERVICES, DIVISION OF HEALTH <br /> (Pursuant to H 65.06,Wisconsin Administrative Cotlel <br /> NAME OF SUBDIVISION C �� <br /> CITY <br /> VILLAGE �j ,/ s <br /> LCCATION OF SUBDIVISION: TOWN XOF ACCOUNTY 8VZMfti'f SECTION `•� ; TOWN 40 N; RANGE�S-W <br /> (Cheek <br /> ��SfOne) <br /> �/{ <br /> NAME OF OWNER `�0�K flo <br /> AOORESS S/49 /9 Ave Soull? Mleo S✓�1�/� <br /> (Number b Straevl�te (Place) (State( (Zio Code) <br /> NAME OF SUBDIVIDER <br /> ADDRESS <br /> (Number a Street( (Place) JSn[d f2(D Code) <br /> SUBOI VISION WATER SUPPLY FROM: PUBLIC WATER SUPPLY PRIVATE WELLS <br /> SUBDIVISION DATA: AREA IN ACRES r•mq NUMBER OF LOTS I /1 MINIMUM LOT AREA,SQUARE FEET ¢ 7OQd <br /> DISTANCE TO NEAREST NAVIGABLE SURFACE WATER ll�;dteO FEET.(IF WITHIN 14 MILE) <br /> NAME OF LAKE OR STREAM f)LIN me <br /> OATES OBSERVATIONS MAKE: SOIL BORINGS SII/� /�lo PERCOLATION TESTS <br /> SOIL BORING TESTS <br /> HuTEST rOTALOa►Tw OE•TIEtOGAOuNOwAtfA..MCMES CMAAACTEROPEACM SOIL LATER WITH TMICkpIESSIM INCHES <br /> me!. mCE•e5 OSSEAVEO ESTv.ArEO n•GmtST <br /> >�48 -S'Be s 5 =l$, 8n. 1!►e�i s 18=361r �>,ft <br /> SFS NE,,.. <br /> °- No x.481r PAM OR rAfJ( S W rRVel 40"J&ck4 Refnel <br /> e- <br /> e• <br /> 1 <br /> e— <br /> ° 1 <br /> (NOTE:WSPACE-ISmo&ADEO.UAT.E TO REPORT.A.LLSOLL.BORINOS,USE AOIDITIONAL FORMS. <br /> "OVER <br /> '9Em <br />