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• <br /> .. ?he existing system must be in nr. ecood for cone to and hi r groundwater requirements of <br /> the code . <br /> If the ex tiny system e does meet <br /> groundwater and bedrock requirements for <br /> � _ rd bedro i depths and if it is functioning , on-, <br /> bedroom could be added in most instances t �- <br /> ' without updating the <br /> existing system and if the existing system utilised for lc the <br /> addition, every attempt should be made to t <br /> �� locate e and reserve an <br /> area which is suitable for a code complying replacement in <br /> case of failure . If more than one bedroom is aoino to be added , <br /> a <br /> substantial increase in discharge would be anticipated and the exist- <br /> ing system shall be replaced with a code complying private sewage <br /> system. <br /> /0,,0 (Sl /0 (,, -i�� �u ti <br /> 4 1 (Subdivision) Section N s <br /> Township <br /> Rural Number Address City Zip Code <br /> , <br /> Parcel Number (tax records ) <br /> (I) (Z'•ie) <br /> A4 k5 eL Jn/(Xfed /\1�� �-f, plan to ((build an addition tom <br /> remodel) the building at the above named location. The present <br /> private sewage system appears to be working satisfactorily . If the <br /> present private sewage system does fail, it will be replaced with(1)one that is code complying. <br /> OCIA ' I -�Ov '1/- e <br /> c #s4 A'—t"-� (2)� e ��� <br /> Owner ' s Siature ) <br /> . , <br /> 0Y 3% <br /> Date <br /> Subscribed and sworn to before me <br /> this <90- day ofc , to ey • <br /> o ary i; , iu- F4c,(2r- <br /> County, Wisconsin <br /> ,0");';, ,Jyy Commission Expires j / -/ ,- gi <br /> ✓;i\ 1 rJ t,. ' DANE-- 0=Ty EVV iii ". ^ HEALTH DIVISION; <br /> ( kanitari an ' s Si r_naturef ' <br /> • <br /> / / t icen a�tac ed <br /> ( snow location of building- ad di <br /> tank) � tion to Clr��1�:_ _Ll1and Septic <br /> 11.xt ac ed from Plumting Code _nte t _.,io: 1(,D <br /> :::13 . 25 ; 2 ) (e )1 , E63 . 12 ( 3 ) <br /> _ .�:.. .�.001�f', .'.�' j•;rrc-•-, EE RECORD= W?`"1: THE i�r. n T• <br /> E "1... _ . _: OF DEEDS t <br /> v�y <br />