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Cowry
<br /> „_ Safety and Bolidings,Division Dane
<br /> ) P4 iti 6-
<br /> 1V1,°13V A 201 W.Washington Ave.,P.O.Box 7162 'seamy pitorlir Number op be oiled in byc,c.)
<br /> it V::08 At Madison,Wi 53707-7162
<br /> 1 5 -2-6 (5-0600G
<br /> Sanitary Permit Application State Transaction Number
<br /> 346570
<br /> in accordance with SPS 38321(2),Vii&Adm.Code,submission of this Ram to the appropriate governmental unit
<br /> is required Worm obtaining a solitary penuk.Note Application kegs tor state-ow med POWIS arestRanitted to Project Adtkoss(irdiffcrect don noting address)
<br /> the Demo:hood of Safety end Professional Swim. Personal information you provide may be used for secondary
<br /> purposes in accordance With the Privacy Law.s.I5.04(1)(angas.--_-7- ----._ 6622 Sunset Drive
<br /> L Application Information-Please Print ARTA On (i' i " ij • r..:
<br /> Property Owner's Name . f i.--1.:L..•-? ..,-, I 1Y
<br /> ,,.,i. ____-- _____--. r'. Pied It
<br /> Four Empt Milk Cans LLC - ::n . f . 608-351-9500-5
<br /> „ . ti 1,:
<br /> Property Ownes/vtailing Address PropertyLoartion
<br /> 1.1 I . JAN - 6 2015 :L.1 ri,,i •
<br /> 702 N.Highpoint Road I —; Govt.1.131
<br /> City,Slate I I VP&Se Phon-ettumber I I SE ;4, NE v,,goion 35
<br /> Madison,WI r 537fr;b..3 -777, ' .,---. I
<br /> 7 ;
<br /> ••, '.-1‘-' i 0 (chat oee5"--
<br /> T 6 ri; R ,-, Err W
<br /> IL Type of Building(cheek all that apply) - -Lois -t'l
<br /> Subdivision Name
<br /> K1 I oil Faintly Dwelling-Number of Bedrooms 1
<br /> 13Iock# - 40 Acre Parcel
<br /> 0 Public/Commercial-Denote Use 0 City or • ,
<br /> eSt4 Humber 0 Village of
<br /> Os Owned- Use Dorcole U
<br /> El Teirn or Verona
<br /> Itl.Type of Permit (Cheek.oitlyotte boron line A. Onnplete fine Et If applicable)
<br /> A' 0 New System 0 Replacement System 0 Trearmeouliolring Tank Replacement Only 13 Other Modification to Existing System(explain)
<br /> _ _
<br /> Reconnection To Existing System
<br /> _ _,
<br /> B. 0 Permit Renewal 0 Permit Revision 0 mange of Number 0 penal Thewrerte New List Previous Permit-Nisoberadd Date isaucd
<br /> BcromEspiration . Owner Dane 99-0513 (8-27-99)
<br /> IV.Type of powrs Systern/ConnionentiDevico: (Cheek all that apply)
<br /> 0 Non-Premixed In-Ground aPressurieed In-Grond 0 IM-ticade 0 Mound>24 to.of tealluble soil 13 Mound.<24 in.,of suitabk soil
<br /> 0 Holding Toth 0 Other DispenetCoraponent(explain) 0 Pretreatment Device(explain)
<br /> V.DispersuitireattnentArea Inforination:
<br /> Design.Flour(gpd) 'Design Soil Apt:irked=Rate( del) Dispersal Area Required(s1) . Dispersal Area Proposed(sr) Sy**Elevation
<br /> 150 1.0 150 501 98.8'
<br /> VL Tank Info - Capacity in Total #of Manufacturer s J.
<br /> .Gattons , Gallons Units :§ 81 , . .1.
<br /> New Tanks Existiog Tants 8 2 15 2 a 2
<br /> a.u WI. so E--t5 F.
<br /> Septic-m.114as Mak 1287 1287 1 Dalmaray . x
<br /> Desie*cieenter • 760 760 1 Dalmaray x _ _
<br /> VIL RespoosibfillyStatement-1,the undersigned,nssurne -. ,,,i -log Installation of the.POWIS She=Olt the atimitedplans.
<br /> ,Phonber's blame(Priiit) P, - S'..? ,iik ' ,
<br /> e ArIPIMPRS Monter Business Phone Number
<br /> C- ç\\,k.,k------,% •- ..7._ c• ' \, ....K..__ aa.o. 4 3 Lo, -klyt{—
<br /> Piumber's Address(Si?a My,Stale,Zip Code)
<br /> • IC3:Di■ tkyvV Z . 'ICDOn. - . 1 L'■---- - SS.SIC\
<br /> VIIL County1Depertment Use Only
<br /> .Pernth Fee V.-- Date Issued Issuing",
<br /> )<Approved 0 Disapproved ZS-7 /-8-l5
<br /> 0 Owner an=&molt for Denial _
<br /> IX Conditions of Approval/Reasons for Disapproval /
<br /> 1.--=-. X.k. v■-•,_S 4-ce,Jrc:___s ,--,-.-%.,- 4-----10-- p c."-...,p- _-91 a- 1-t €P.-,es% -e---e-ri
<br /> Grvr-co-d-e_ cb_.-reA- --,._
<br /> Attach le complete plasm far the sy,stem Rod submit to the Comstp a*act paper not less than I la 1 II belies la sin
<br /> f' --Z3 23
<br /> SBD-5398(IL 11/1 0
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