Laserfiche WebLink
Per '55 03-7Z4•/7ocst,, <br /> PRIVATE ONSITE WASTEWATER TREATMENT <br /> SYSTEM COVENANT: ADDITION/REMODELING <br /> DOCUMENT h <br /> This covenant is between i916 /J/nirdWbf t(/IT 1/ 3: , ,;M <br /> Trans. Fee: <br /> grantors,and the County of Dane,regarding the private onsite wastewater E e ref o # <br /> treatment system(POWTS)on the following described parcel(s)located in the Rec. Fee: L_,g>? <br /> Town of CM/raw/ft Pages: <br /> in the f J � quarter of Section (0 1 ,T N,R E. <br /> Type or neatly print the legal description of your property in the space below. if r J <br /> you need more space, use the reverse side or attach a copy of the deed.) Record this document with the Register of Deeds <br /> n F t (.0<•_/� S C C n Your name and return address <br /> t V / y/!tC6144- 2 l3R 2Tikmiti <br /> C l teActi <br /> c Boi w't S -3 <br /> Tax Parcel# 19/6/e6/.2 -z2 ?'t,?3i 7' <br /> I(We)the undersigned are applying for a building permit for a repair,alteration or addition to the dwelling located on the <br /> above referenced property that will involve 25%or more of the existing living space or the addition of 1 bedroom. This <br /> construction is intended to accommodate existing family members only. <br /> In compliance with the requirements Dane County Code ch.46,or acts amendatory thereto,this affidavit is to <br /> acknowledge that the existing POWTS(is)(is not)sized in accordance with the current regulations for the wastewater load <br /> generated by the building served by the system after this work is finished. This is also to acknowledge that there(is)(is not) <br /> an approved area for the purposes of siting a replacement POWTS on this parcel. <br /> I(We)certify that the existing private sewage system is not failing by causing back-up of sewage into the structure, <br /> discharge of sewage to the ground surface or discharge to a drain tile. I(We)agree to replace the system with a code <br /> complying system when and if any additions or changes to the structure result in additional wastewater load as determined <br /> by definitions or criteria in state and county code,and/or when the system fails as defined in s.145.245 Wis.Stats. This <br /> agreement is binding upon the owners of the described parcel and his,her or their heirs,successors or assigns. <br /> ACKNOWLEDGEME T/ <br /> 1/21N11 <br /> Owner Name(Signature) Owner N - e(Signature) <br /> 1?�1rc,11 /2. Y 4' V 1 t":01 it•? a - artivrayi <br /> Owner Name(Print) Owner NatrPrint) <br /> STATE OF WISCONSIN ) <br /> } ss. <br /> COUNTY OF DANE <br /> 4 it Personally came before me this day of 1�I ,the above named person(s) <br /> to me known to be the persons who executed the foregoin strument I( (owl ed the same. <br /> • <br /> 4Ti (•C'It 7t,241%..: <br /> otary Public Dane County,Wisconsin <br /> My Commission is permanent. (If not,expiration date is /6-111_07) <br /> Dane County Environmh:tal Health 5X)1 <br /> �( <br />