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2016/08/02 - SANITARY - SAN - Other - SAN-16-131
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2016/08/02 - SANITARY - SAN - Other - SAN-16-131
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Last modified
3/5/2020 6:41:33 PM
Creation date
10/2/2017 10:19:49 AM
Metadata
Fields
Template:
Property Files v2
Document Date
8/2/2016
Document Type 1
SANITARY
Document Type 2
SAN
Document Type 3
Other
County Permit Number
SAN-16-131
State Permit Number
588734
Tax ID
2643
Pin Number
07-006-2-38-17-28-5 05-004-012000
Legacy Pin
006242801800
Municipality
TOWN OF DANIELS
Owner Name
RICHARD M GOIFFON REV TRUST THERESA A GOIFFON REV TRUST
Property Address
23190 DUNHAM LAKE RD
City
SIREN
State
WI
Zip
54872
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POWTS DESIGN <br /> Residential Application <br /> / <br /> Index and Title Page <br /> Owner's Name: �jc f�i4r'a' &O1�`(—r ic7 <br /> Owner's Address: :71Y.Jr &A/9, Z t 0 <br /> _e- :re of 6V T__5W72 <br /> Site Address: Q :yA. A M L K 10 <br /> Legal Description: ,D c-/ G,� y `a X287_3AYA),e /7 Cc) <br /> Town: _S�/ <br /> County: ct i �e�// <br /> Stt�n/CSM: ✓ 02 c Lot No. j Block No. <br /> Parcel ID#: <br /> Page Index <br /> Page 1 P10 Ply <br /> Page 2 <br /> Page 3 <br /> Page 4 <br /> Page 5 <br /> Page 6 <br /> Plumber Name: WADE RUFSHOLM Credential No. 227691 <br /> Plumber Address: P.O. BOX 513, SIR,�EN,, WP�I 54872 <br /> Signature: <br /> Date: y7.3Phone No.715-349-7286 <br /> Designed Pursuant to: <br /> In-ground Soil Absorption Manual for POWTS,Version 2.0 SBD-10705-P(N.01/01; R. 10/12) <br /> Pressure Distribution Component Manual,Version 2.0 SBD-10706-P(N.01/01;R. 10/12) <br /> Mound Component Manual Version,2.0 SBD-10691-P(N.01/01;R. 10/12) <br /> Holding Tank Component Manual Version, 2.0 SBD-10855-P(. 03/07;R.01/12) <br />
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