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Environmental Health Division <br /> ••••• 2300 South Park Street, Room 2010 <br /> •• •. Public Health Madison,WI 53713 <br /> MADISON & DANE COUNTY Phone(608) 242-6515 <br /> Healthy people. Healthy places. Animal Services Voicemail (608) 267-1989 <br /> Fax(608) 266-4858 <br /> www.publichealthmdc.com <br /> Building Permit Review Application <br /> Required for all building addition projects resulting in an increase in total square footage of 25%or more and all <br /> additions/remodeling that change the number of bedrooms in a structure served by a private septic system. <br /> Applicant(Owner or Authorized Agent) Kyle Williamson Phone: 608-720-8195 <br /> and Owner(if not applicant) <br /> Address of Property Owner 681 French Ct, Oregon, WI 53575 <br /> or Authorized Agent: <br /> SW 1/4, NE 1/4, Section: 24 Township: Oregon <br /> Location of Property: <br /> Subdivision/CSM: Jefferson Village Lot 10 <br /> Parcel Number: 042/0509-241-4090-5 <br /> Property Address: 681 French Ct, Oregon, WI 53575 <br /> Existing House and Private Onsite Wastewater Treatment System (POWTS): <br /> Type of POWTS: (check all that apply): <br /> ❑ In-Ground Trenches ® Mound ❑ At-Grade <br /> ❑ Aerobic Treatment Unit(ATU) ❑ Holding Tank ❑ In-Ground Bed <br /> ❑ In-ground Pressure ❑ Seepage Pit(Drywell) ❑ Cesspool <br /> Date of POWTS Installation: 5/19/1995 Size of Septic Tank: 1600 gallons <br /> Soil Absorption Area: 376 Square Feet Last Pumped: April 2020 <br /> Age of Existing House: 25 years Size of Existing House: 2500 Square Feet <br /> Number of Bedrooms: 4 <br /> Type of Proposed Construction: <br /> ® Addition <br /> What is the size of the addition: 968 sq. ft., Dimensions: 22'x22' main floor and <br /> basement (great room addition-per HO) <br /> *Does the addition contain bedrooms: I Yes® No If yes, how many: <br /> After addition, Total number of bedrooms: 4 Total number of people using home: 5. <br /> Remodeling If remodeling, how many Sq. Ft.: <br /> Describe Remodeling: <br /> Rev.4/17/19 <br />