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2024/02/16 - SANITARY - SAN - New HT - SAN-23-172
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2024/02/16 - SANITARY - SAN - New HT - SAN-23-172
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Last modified
6/13/2024 2:20:18 PM
Creation date
2/16/2024 11:55:04 AM
Metadata
Fields
Template:
Property Files v2
Document Date
2/16/2024
Document Type 1
SANITARY
Document Type 2
SAN
Document Type 3
New HT
County Permit Number
SAN-23-172
State Permit Number
654858
Tax ID
19196
Pin Number
07-028-2-40-14-05-5 15-575-035000
Legacy Pin
028922503500
Municipality
TOWN OF SCOTT
Owner Name
DANIEL K & ANN C STUDNICKA
Property Address
29251 PINE KNOLL LN
City
DANBURY
State
WI
Zip
54830
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PAGE 1 OF 4 <br /> Holding Tank Plan <br /> Index & Cover Sheet <br /> Component Manual Design References: <br /> Holding Tank Version 2.1 (May 2022-2027) <br /> Pg 1 of 4 Index & Cover Sheet <br /> Pg 2 of 4 Plot Plan <br /> Pg 3 of 4 Holding Tank Specifications <br /> Pg 4 of 4 Management Plan <br /> Attachments: Enclosures: <br /> POWTS Application for Review <br /> Soil Evaluation Report & Site Map (if applicable) <br /> Holding Tank Pumping Contract (if applicable) <br /> Holding Tank Agreement (if applicable) <br /> Project Name / Description <br /> Owner Name(s): 4,0 S7L41 1 ,s k,4 Phone: - - <br /> Owner Address: f3,9 Por-"ty e. LA)5"h44ka,ee vrm,U Zip: 5-5-3 7 51 <br /> Project Address: 9 7 / Aeie, (C,,vc/I L,,cJ <br /> Govt. Lot: 1/4 of 1/4, Section 5 , T 5"o N-R /9 E❑or W <br /> Township: .S County: 1 -# <br /> Project Parcel ID #: 67 o ag yo /y o s s- /S S7T o 3 sc o <br /> Designer Information <br /> Designer Name: iklor p c /i-7-? Phone: 7/5 - 62,792 <br /> Designer Address: Jel&y/ S/� 71 1. Zip: 54 7c <br /> I ran, tvz <br /> E-mail: LUur/ o gr jrehdm _r/ Win This space reserved for approval stamp. <br /> License Number: o 7(,Q/ <br /> Remarks: <br /> Signature: flogeh, Date: &-,26-. 3 <br /> Original signature quired on each submitted copy. <br />
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