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2024/06/13 - SANITARY - SAN - Repl HT - SAN-24-118
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2024/06/13 - SANITARY - SAN - Repl HT - SAN-24-118
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Last modified
6/13/2024 2:12:15 PM
Creation date
6/13/2024 2:10:43 PM
Metadata
Fields
Template:
Property Files v2
Document Date
6/13/2024
Document Type 1
SANITARY
Document Type 2
SAN
Document Type 3
Repl HT
County Permit Number
SAN-24-118
State Permit Number
658573
Tax ID
5519
Pin Number
07-012-2-40-15-23-4 02-000-018000
Legacy Pin
012422305500
Municipality
TOWN OF JACKSON
Owner Name
DANIEL ELLIE KATHY J ADAM JEAN M ROSEKRANS BRIAN J ELLIE GREGORY G ELLIE DAVID A ELLIE
Property Address
28131 W BASS LAKE RD
City
WEBSTER
State
WI
Zip
54893
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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): ,b/4-0, s //i Phone: 7/51 3.27- oL 35' kelly <br /> Owner Address: 30.25 Zo,sj ied Z7 i*'cj a� GrY), G if Zip: S5/4/y3 <br /> Project Address: 02f/31 a) 1 Ass L 4- (€- kr) z o'tV csiV! P2.23 <br /> Govt. Lot: a Pc-I4 1/4 of 3 67- 1/4, Section a 3 , T _/ N-R / 5E❑or W <br /> Township: S/4c.k5'o. ) County: 04(3u trt>e_l/ <br /> Project Parcel ID #:0 7 i 23 oob o/8000 <br /> Designer Information <br /> Designer Name: ()dark /irk m Phone: 7/5 cllp - 9. 92 <br /> Designer Address:R31,eby 5/4 o?/17,0A L/i'4i Zip: 54�70� <br /> /� / <br /> E-mail: LU(,�(1/f'(/f ehOlmOz/, CONY) This space reserved for approval stamp. <br /> License Number: o 7Lo9/ <br /> Remarks: <br /> Signature: c�. Date: -5 -2 Y <br /> Original signatur required on each submitted copy. <br />
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