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Public Health
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<br /> Eo°"°r;e"ueumo m.owp 6.0f.i 242-5515 Wel'usepx
<br /> 2n1 /,fpmaoyxa/Lace S,le 608 243'0333 u" smam.ao~ow
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<br /> Building Permit Review Application
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<br /> ' Aodfess of Properly Owner or
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<br /> EXISTING HOUSE AND PRIVATE owmre WASTEWATER TREATMENT s,arsm{powru.
<br /> Type of POWTS ,c,ec^*'/,al«n^ /
<br /> VJu sewurm^ �l �e=*" r~x"e"'u,^ �� y°°�n �*
<br /> LJ Seepage n*nc, LJ a�nuep^p~=°^. 0 uv.p*
<br /> • At Grade r—lo`o.�mup'*�°"� Elce"°pow/
<br /> Other(explain).
<br /> Dr-of POWTS in ` /x 'I—I 4— 7ft o°"°.,t t.tne"./"ow/"»o"
<br /> Size of POWTS Tank nn/ono Soil Ac.fsscp:o,Area_ Square Feet.last pu=wm�------------
<br /> Anu.a/e,.w",n Howse @A.,1!) years a.:fau/e,o cc, louse_ a*=,°Feel,w"x.*^.u/Bedrooms'
<br /> TYPE OF PROPOSED CONSTRUCTION:
<br /> [] Now o.m,/",r El Replacement u,'":/",°f.,e a",o.m,r/^aox`,f./ex^"+x^^*.r",^,'.etc`;
<br /> R-e"mn,i0/."o x.e",^"`w."u ,"=,`a",onr, I IS- _ n°=.`mna,"*"a"ne
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<br /> 'x"dm.^vn,^*m.sm°"uo°//=noo.oe. 3 Z�� °.; /. o/me"^,m �»^^���/ Type
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<br /> r"fa,wnt,".m"td'oom"°aw blot mrr".,moeo= OS"onmc:LremysTm Mite mdif;;*; ,
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<br /> povno^/znn`,uafseff"'`uppavlo par»em,"mvwngranao�.,.o^.watt-per v^m*n our owv./
<br /> PLOT PLAN:
<br /> ~'v"'``o*fi,^N"ou/your''odenvo'o=w,o/po,^1,.?..p'a`e',o=o/`svnmn"x~.=/o,onevv=.`s>,ex.s^nnPoWToand
<br /> POW rerep/u:ed:,"'atr°tit k"^nm" *`,`.s^"««^. t,°'* ."�'mo"u."'~:"o.m.v.m^*`.".� .,wa^'.v/°'.°/..v`",^o.,*`u.°
<br /> between above
<br /> xopuWrs.^found mu"°cesspool",.s found discharging onto the surface v'the ground=into ground water,surface
<br /> water,",bedrock m"the above property,this will^.considered powru failure and the failing poWTS will uvordered .
<br /> corrected.
<br /> Signati p m Owner or a.gt rtz d spent co tegolitto artd mm.cm*,'veaoo*'^lc.'atmwma^c.ramwow bust"'yew^""°/°uy°
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<br /> moN atua'si two to�l for revii,''.-A,mbe coinplemo °tm.�itd,nfow^noo,,/e.:-m,of.fa
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