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04/23/2109 07:36 FAX 6087423947 LMS CONSTRUCTION INC 001 <br /> __ _.� 7�.7- —:-1 <br /> i f`Iv,_1 E Ihl ' <br /> r • - r"..—.1— <br /> s; .:,. 1,, <br /> , . .,. , , ,11 <br /> ., 1. : . . ■I it <br /> 1 �me�''1- <br /> 201 W.Waslliagl ° <br /> x 7162 Dane <br /> i Is�i_ ' aid 537D�716� <br /> IS Ot ': ! lii: !'e�iii WC. ice,Y <br /> ermt N <br /> tn ber <br /> (w <br /> fed in by Co.)re na + <br /> Department at cs - ., r„ro" : ! Lr._pit _ <br /> sue Tr�►esolla►Number <br /> wSanitary 'e�rinA. lieatioI <br /> 10 moor nn.11321(11321(2),Wis.Adm-Coda r of rasa to the eepp,vpn <br /> terite guvemnC°a,o� PyxAdae ,f dialed thenmtins <br /> ) <br /> unit is required to obtaining o � a fti°d lbme fo�'be t.ad POWiS ' <br /> submitted t o the Department ns � infort tlon Ya"Pmt 3398 CTE{V <br /> :iRomaine kith , Law e.15.1 ,m, a <br /> j I A,. cation]oormation—Please Print All Information Parcel# <br /> 0910-013-9000-8 <br /> Property Owner's Noma <br /> ■ Robert Rademacher III Property Location <br /> Property Owear'e Mailing Mehra Oavl Lot <br /> I 3398 County Highway V gW �� SW ,i, s«tins 1 <br /> it Sate (circle one) <br /> T 9 N, R 10 Borw <br /> Deforest,WI <br /> I H.Type of Bending(check aU that apply) <br /> Ili l or2 Family Dwelling—Number af3edroaan________'- Snbdirisioa Neno <br /> 40 Acre Parcel <br /> ❑City of <br /> ❑PublitlCotltmetaial—�eratbeUse <br /> ❑Village of CSMNua+ber Windsor <br /> ► ❑State Owned oerctTe0ro IR Town of <br /> only one boa on line A. Compete Gas B If applicable) <br /> I I]I.Type of Fermin (Chock y t Only 0 other Modification to Smiting System(explain) <br /> p ❑P1ct+syatete peplaerneel <br /> 5yate,n ❑Teeatn+mUHaldiagTrnt Replvneanm <br /> List Previous Permit Number and Date lamed <br /> I]above of Plumber 0PermittwofertoNew <br /> H. J]Penult Renewal ❑Permit Rrsrisioo Owner <br /> ISettee Expiration <br /> ► IV.T i• of POWf3 s tem1Com.one°t/Devicer Check aU that it:J• <br /> CI 1+rassurtzed lo-Around CI At-Grade la Mound>24 in.of seltabie soil Q Mound<24 in.of suitable soil <br /> Q Noe Prassurhxd fn-010tW ❑Pretteorme nt Dwko(e:tpliink <br /> El Haldn{Task ❑Otber Mapasni Component(atplem) <br /> Di P Irealn Sa Iaformaon; <br /> Design low(gP� Design Soil Application Rate(SpdsQ D,epaed Area Required(<n Dispersal As <br /> e Proposed( ) SY61em Standen <br /> •4 50 1.0 450 450 <br /> vii.'rank Info "� Tom 11� <br /> Oellone <br /> . iiiiilliiiiiiNI lA ii i il j. <br /> et 1000 1000 �-� <br /> s 600 - <br /> oasleg••weber 600 <br /> VI.R onelbUl Statement-I,the enders ed,assume responsibility for trrtallatloo alibi POWIS shwMP a o S N <br /> thume attached Badnes Phono Number <br /> Phoebe's Nata U Plumber's 5 .. sue <br /> --1Le1 Gamin- /- 75 f 7 Los,- 7...7' <br /> le <br /> Plumber's Address(Ballet.Ci4'1 lasts Zip •• ) / /� 6);�Za-ra ad-- e. /4 brake.. <br /> VIII.Colts /De arttneat Use O Permit ee Date hsaci nk Sign.ttuo <br /> Q Owner give 9 808.410 t3'M-1' . ■ <br /> 0 O�Qir�)RasmtforDenlat <br /> iIX.Coltdltloae of Apyry ayRepsoWtrvr D'eerpproral a <br /> 1 --7;,.--.. ... ._...e,._ '''''''' ''.,---,de - --.." •4°- '4°1--1- '''‘''''' ‘`'''-4- • <br /> AtvrabNprpfNepleae tor taa. bre <br /> "' = 1� /AlD, ANEtCOUNTreIN AO <br /> b 6 1 3 <br /> 2 o Q I ENVIRONMENTAL HEALTH DOES NOT HOLD ITSELF <br /> — LIABLE FOR ANY DEFECTS IN PLANS OR SPECIFICA- <br /> SeD-t;s�e(�,oI/o�v,aia olro9 TJONS, PLAN OMISSIONS, EXAMINATION OVER- <br /> SIGHT,CONSTRUCTION OR ANY DAMAGE THAT MA r <br /> I RESULT IN OR AFTER JNSTALLATION AND RESERVE;. <br /> THi=RIGHT TO ORDER CHANGES OR ADDITIONS <br /> SHOULD CONDITIONS ARISE MAKING THIS <br /> I NECESSARY. <br /> i <br />