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commerce.wi.gov County <br /> Safety and Buildings Division Dane <br /> tii SCO n s I n 201 W. Washington Ave.,P.O.Box 7162 Sanitary Permit Number(tilled in by Co) <br /> Department of Commerce Madison,WI 53707-7162 13-2016-00048 <br /> Sanitary Permit Application State Transaction Number <br /> In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate <br /> govemmental unit is required prior to obtaining a sanitary permit.Note:Application forms for state-owned Project Address(if different than mailing) <br /> POWTS are submitted to the Department of Commerce.Personal information you provide may be used for <br /> secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. <br /> 1.Application Information-Please Print All Information <br /> Property Owner's Name Parcel# <br /> GARY M KARLS 0606-323-8732-5 <br /> Property Owner's Mailing Address Property Location <br /> 10795 N PERRY ST Govt.Lot <br /> City,State Zip Code Phone Number NW 1/4 SW 1/4 Section 32 <br /> BLUE MOUNDS, WI 53517 (circle one) <br /> T 06 N; R 06 E <br /> II.Type of Building(check all that apply) G Lot# <br /> Q 1 or 2 Family Dwelling-Number of Bedroom 2 Subdivision Name <br /> Block# <br /> ❑ Public/Commercial-Describe Use <br /> City/Village/Town of <br /> El State Owned-Describe Use CSM Number <br /> 08095 <br /> III.Type of Permit:(Check only one box on line A.Complete line B if applicable) <br /> A. 0 New System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System(explain) <br /> List previous Permit Number and Date Issued <br /> B. ❑Permit Renewal ❑Permit Revision ❑ Change of Plumber ❑Permit Transfer to <br /> Before Expiration New Owner - <br /> IV Tvna of PflWTC C, ta.,,/f mmnnnnnt/ilnv:oo•/nhnn4 oil+hot onnlv\ <br /> CERTIFIED SURVEY MAP <br /> WILLIAMSON SURVEYING AND ASSOCIATES, LLC <br /> IA NOA T. PRIEVE & CHRIS W, ADAMS, REGISTERED LAND SURVEYORS <br /> 104 A WEST MAIN STREET, WAUNAKEE, WISCONSIN, 53597 PHONE: 608-255-5705 <br /> Located in the NW V4 of' the SW V. of' Section 32, T6N, R6E, Town of' <br /> Blue Mounds, Dane County, Wisconsin. Being all of Lots 1 &2, C.S.M. No. <br /> 8095, Vol. 43, Pg. 154-155 <br /> FD. ALUM, MON, SCALE 1" = 200' <br /> SEC, 32-6-6 — — PREPARED FOR: rrj 3 y <br /> = <br /> Tcu <br /> 0' 100' zoo' GARY KARLS x 400' 600' P❑ Box 12 N = " <br /> m 5357DREB, WI WW o 8 <br /> v LEGEND .4 <br /> WWko <br /> I N (S 89°50'13' E) = SET 3/4'x24' REBAR A tiN <br /> S 89'44'02' E WT 1.5 LB PER LIN FT Dj w °o <br /> � W .o <br /> 408.84 • = FOUND 1' PIPE L y Z Ic CI,n)(##) = RECDRDED AS ce w a <br /> cv. F CO <br /> �O I 0 ✓N 66' SHARED DRIVEWAY z o0 <br /> \?' too EASEMENT PER DOC. a ww <br /> CO �� I u) W 3 5189132 ; -J-J <br /> to LOT 2 71.29 <br /> N 5.15 ACRES 303.29 elt‘—\ <br /> DR 224,374 •' :...., ,,s <br /> so. FT. • N,v NOTES: <br />