Laserfiche WebLink
3 <br /> I - ,1k_ <br /> - _ _., !i :i'!da^I,j nA,- P J Bo;;7I32 :.trtha P:rn[`i,mo_ri o)c rifled n:wGi l <br /> ' Madi>oc•+,1/! 53707-7132 <br /> 3—.)-0i6 •— 0O S <br /> t—r _ <br /> :D i1lia f =:(• _lit : '__J_;)! allot i late Tnnsacooc`iurr!brr <br /> In accordance.vi;n S?S 3.331(?/"Wo Adm.C Sr.it vi;;irm a il is porn to he venerate governmental unit <br /> is required prior to obtaining 1 sanf;ary path. `se:...ppi,cat:on fo,n;for state-o.ned?0'},T3 are submitted io Prajact Address(ii ii8',r_nt than mailing oedres:j I <br /> the Department of Safety and Proicsrional Sans;. ?e tonal information you provide may be used for se^_andar I <br /> oumas. ir.accordance..•.it:.'ha art:a`:La•x. i:I-r".'AM',Slats. I C Jk t2o t NAL PO L iV i- 11�A LL.// <br /> I I.Apolication Information-?le.ase PI-in"Ali:3-Formation <br /> I Property Owner's Name Parcel <br /> I <br /> an< Inlvt,Srtv1 C t4-r..5 0`705 -.2..03 - 349 -° <br /> Property Owncr's hlaiiing Address Property Location 1 <br /> I 7'702 PAyve2y TRAIL Govt.Lot <br /> City,State j Zip Code I ?hone Number N t,i S I <br /> 11 wu YV v,,Section cal d <br /> 1 M I 0 0 L e.-fv�. Intl•I 1 5 a S U .. - <br /> ( T r7 v: R 8 - <br /> • <br /> I�If.;Type of Building(cheek all that apply I Lot i <br /> tilt]Itor2FamilyDwel ling-NumberarBdroorrs �e I �j� Subdivision Name ' ' i <br /> R ��� PO S P(4-∎A C e >-Iciu_o w <br /> ❑PubiiciCornancrci:d-D=trice Lse I— i <br /> i <br /> I f City of <br /> IQState Oc:ned-Describe Use cif`r .3 0 ?I CSM Number 'tillage of <br /> 2Town of M 10+0 L.ETC,rV . <br /> I I'utH:^ooRh viD <br /> Fn,i:.._ 1 <br /> M.Type of Permit: (C'hee'r only one'nom on fine A. baZipt t (R applicable) <br /> A' 1❑New System IL Replacement 5.,steer ET•eaTcm/Holding Tank Eteritteemenalgnir I 20ther to Custin3 System(=plain) <br /> I j ! <br /> M0i tw / LRe-avy INSmwEb- - <br /> - List previous?.unit Number and Date Issued <br /> 3. II0 Permit Renewal �!'•_,Permit g.dsic n III Change of Plumber I OPermit Transfer to New <br /> 3efore E:pinrion I 1 1 Otter I A-80-54r5- 9130105 <br /> IV.T'raea:PO'',^'S3,.i.:miC'aa:na_1_r,'__: '='acc'i all that soul,' 5ifN-'175 G ' <br /> ONon-Pressurized In-Ground 0Pr ssurfzrc in-Craund az-Grade E-Mound 24 in.or iuitabiesoil 1 IMound<34 in.or suitblesoil <br /> Holding Task JGtiscr Dispel Compan_at(?lain) OPretretment Device(explain) 1 <br /> V.DispersallTr_atmcnt Area Informato <br /> Design How(gpd) I Design Soil Application iatet_-pdse, I Dispersal Area Required(st) ` Dispersal Area Proposed(sf) System Elevation i <br /> 750 '� . L 4 /..2,_s...-2) 1 f3v(o toa.� ' <br /> VI.Tan Info Capac y in Total m of Sian riactur r ( E. - ei I =_ = <br /> Gallen Gallons Units 111111 , <br /> New Tanis :..stn_c Tsnbs .? S ' <br /> I I 1 u.1'.) v:r at ( a.-. — 1 <br /> I septic or Holding Tank tip,�5 0 4 i I(,s o �' I M e-A o f � �'J [ ;I 1 I jt • <br /> (:.sing Chamber I Poo /1 I 6o0` ( 1 1r-A0 JC I j 1 <br /> t VII.Responsibility Statement-I.the undersigned,assume responsibility roc installation of the POINTS shown on the attached plans <br /> Plumber's Name(Print) I Plumber's Signature / irfPc MPRS`lumber Business Phone Number I <br /> Andrew VV Nieinholz 1 A�^ i,„., "�- 2201SS 608-331-8103 � <br /> IPlumber's Addrrs(Sweet.City.State.Zip Cod:) <br /> 6813 County Highway K,Waunakee 1:41 53597 <br /> YllkCounty/Deparrnent Use Only � <br /> ,,u,( I Fee Dale Issued I Issuing.4 t Signature <br /> Approved ❑Disapproved I / <br /> 0 Owner Given Reason for Denial 3 14 I Z'SI'lo ��/ �� ! <br /> 1 LK.Conditions of AoprovaUReasons far Disanprovat le4011/( 1 <br /> 1 <br /> .angle to comntety?lam:.n t:.a s:sens 3.,13 submk to the County%sty en ypec sot less:heal t.?t 11 inches in tier <br /> SBD-6395(R.lilt <br />