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• 111111 <br /> POWTS AGREEMENT 8 8Tx688825 6 <br /> Document • Deamwnr Ted <br /> KRISTI CHLEBOWSKI <br /> This - eat is made between: N .w -r PO*g•.•• DANE COUNTY <br /> and the County REGISTER OF DEEDS <br /> of Dane re: •ing the Private Onslte Wastewater Treatment System(POWTS) <br /> located In h.Town oil "AAt09 DOCUMENT # <br /> In the N 1/4 of the P) 1/4 of Section mei T. 4 14.,IL 0 )1 <br /> Specifi :(Type or neatly print the complete legal descr/psion ofyour property <br /> 5170577 <br /> to the s;-• below.The legal deserOdon is on your deed and usually on your tax 07/22/2015 3:56 PM <br /> bll!) Trans.Fee: <br /> Exempt#: <br /> e'T / C.SM /Z/1• .L.. Rec.Fee:30.00 <br /> Pages: 1 <br /> Recordist g hebnoellon: <br /> Taallow and Resendddrue: <br /> Cr04.EaNj Weir -dc,/ <br /> 7/&Er 4001-�ioA/0aawoltf'te,o <br /> R,. <br /> Go0P W/• S3SZ'CS <br /> 0908- ZOZ -85'40 3 <br /> Tor Parcel?lumber <br /> At the abo e named location l3(i)❑(We),plan to(check all that apply): <br /> 2/Build house addition or remodel an existing house resulting in an increase in bedrooms/wastewater, <br /> 0 Build replacement residence or additional structure and connect it to an existing POWTS, <br /> Build., Additional Structure and connect it to an existing POWTS. <br /> The . •••i POWTS has been determined to be in compliance with bedrock and groundwater standards contained in Wisconsin <br /> Admin . •ve Code(COMM83).le' {1)❑(We)understand that the sizing determination of the existing POWTS is being based on <br /> the,}rum of people living in the house in lieu of total bedrooms.The total number of people utilizing the existing POWTS will be <br /> 9 . ,•le. <br /> • <br /> 17015115-1,111Fr <br /> 't Signature <br /> k--\ r <br /> Date <br /> ,,%%%11(Id.,.,,, <br /> Subsc •- sworn to before me ,,.,``��N E A yq'•,,, <br /> ILA day,of3 - 5 ,.• .AO" <br /> *I L NOTARY <br /> NPa�ryLPub o <br /> My • on rn <br /> Expires ° - �- � = PUBLIC : <br /> • <br /> morel • tali.wMe.wmrrylYia.a.l►Md..ao..•Ce.I <br />