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Jul. 9. 2009 11 :48AM No. 0914 P. 2 <br /> �J�0M ' <br /> PRIVATE ONSITE WASTEWATER TREATMENT <br /> SYSTEM COVENANT: ADDITION/REMODETANG <br /> This covenant is between_..Ti LL a^A 5(41 Leak sue\ <br /> grantors,and the County of Dace,regarding the private onsite wastewater • <br /> treatment system(rows)s)on the following described parcel(s)located in the <br /> • <br /> Town of Lr .553 11(at sJS , <br /> in the, quarter of Section ,. N,T ^ R-7 E.— , k:_;:t7 <br /> Type or neatly print the legal description of your properly in the space below. If : --i.. <br /> you need more space, use the reverse side or attach a copy of the deed) Record this document with tie Register of Deeds • <br /> Lek- 11 Q"I It Lo{- ' o 0A4.00,1141 65-i-alt$ 'our name a ,return a, ess <br /> CormAtNGii a�.lkc, ,OorNeaS� cornet" a( La 7� 5c:aft '�"°'Q�t�r(!' •5zcct�s <br /> c-7'SI �Ut-t"Oak <br /> Cr• 635P8 <br /> 055 Pler trt5 's <br /> Tax Parcel# 624/6747- -013--MO'TO <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 tie existing living space or the addition of I 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(01)(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)(amt) <br /> an approved arcs for the purposes of siting a replacement POWTS on this parcel. <br /> • J(We)certify that the existing private sewage system is not failing by causing backup of sewage into the structure, <br /> discharge of sewage to the ground surface or discharge to a drain tile. 1(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 defned in 8.145.245 Wis.Stets. 'Ibis <br /> agreement is binding upon the owners of the described parcel and his,her or their heirs,successors or assigns. <br /> ACKNOWLEDGEMENT <br /> __....),...i_l_...111.,„...z__ _ <br /> Owner Name(Signature) Owner N. :ignature) i c o L�l 8b)au - ,gi t A'tie` frirla .- <br /> Owner Name(Print) Owner .. e(Tint) <br /> STA i i OF WfSCONSIN ) <br /> ss- <br /> CL'UNTY OF DANE . ) ""� <br /> Parsonelly.canicbefore me this- ._ y 1 . . ___day of ] 'Of 91,.the above named persons) <br /> to nic known to be the persons who executed the foregoing instrument and owledged the same. <br /> • s .. I. t A••1 OM liti... <br /> Notary Public Dane Cntliity;'1�rt�:...►n.' r' :. <br /> 11 <br /> My Commission is penr� t ,It- 01aa_ u n. ate.s. N'tt�DO <br /> trim:County Environmental Health SJOt Il r'}1 i � p 8 ^Ot�0� t i <br /> {; L ! <br /> IL Li <br /> ;• �1):I lib rig%∎1111 MOO } 1 <br /> 1 �t�Vll<ri t::0:I�.,tt f•i:s•4jLh._.,...t t <br />