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Nov 071612:03p A-1 SEWER SERVICE, INC 608-8469098 p.1 <br /> Nov 07 16 09:10a Assn,Consultants..Osborne 608-831-3590 p.1 <br /> s ='Public Health <br /> MADISON Sr DANE COUNTY <br /> Hcaly peopr artdpIacrr <br /> kIOLDING TANK SERVICING CONTRACT <br /> This contract is made between: r rJ II a � (( �j�- <br /> 8 iec E k s k,. (141 /0227_ U)o,-c-I�,.�wv�C.. PA I) Or-41\ WT as y Z <br /> Property Owner Address Po L3ax 6-4 00\4 City Zip <br /> Pumper's Name Address City Zip <br /> Property Description: <br /> Y. Y4 Section 17- row ity of_ v ci )P )'6 h <br /> Lot J)- CSM/Subdivision —" hh C <br /> Tax Parcel No.07-0Y-1J—Prcperty�{ddress I d T 7'� ,���C k k,.1 4 p ` l le L La- <br /> 0,0.0_6 f I s'3S6 Z <br /> A copy of this agreement is required as a condition of obtaining a sanitary permit for the installation of a holding <br /> tank-system to serve the structure located on this property. <br /> 1. The property owner agrees to have the holding tank serviced by the above named pumper. The pumper <br /> is granted access and permission to enter upon the property for the purpose of inspecting and servicing <br /> the holding tank(s). The property owner agrees to alntain an all-weather service road or other approved <br /> access for the purpose of servicing the holding tan (s)at any time. <br /> 2. The pumper agrees to submit the report of servicin done for this holding tank to Public Health Madison <br /> and Dane County (PHMDC), Environmental HeaithlDivision. Reports may be submitted immediately <br /> following service or on a semi-annual basis, no later than January 10 and July 10 of each year. Reports <br /> must be acceptable to the Division and comply with Dane County Ordinance 46.06(5). <br /> • <br /> 3. This agreement will remain in effect until the owner�Or pumper terminates this contract. In the event of a <br /> change in this contract of the change to a different service provider, the property owner agrees to submit <br /> a new or revised signed service contract with PHMDC Environmental Health Division within ten (10) <br /> business days of the change. I <br /> 4. The property owner agrees to notify the Public Hea h Madison& Dane County Environmental Health <br /> Section when there is a transfer of ownership of thi property,within ten (10)business days after the <br /> change of ownership. <br /> • <br /> ACKNOWLEDGEMENT <br /> � / /I I/ //. --i!S! <br /> Ow er Name(Signature) ' mperNa'e (Signature) <br /> De_e.1 p V a Ox rrn.2 - rue - ,_ <br /> t7:r. o F ,1. <br /> Owner Name(Print) ) Pumper Name(Print) <br /> Date: 'II r 0-71 /Z License i Sy# 9 97 <br /> I , <br />