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HomeMy WebLinkAbout022-1026-80-000okb sm Bullmnp oi.ision a" PRIVATE SEWAGE SYSTEM St. cri INSPECTION REPORT wv.mmx. GENERAL INFORMATION (ATTACH TO PERMIT) Sal Plain to NO 624906 Pai inforsaturn Nor snoods say N., roars n P (. nNm➢ Wind, T,si William IIIJutllth Snoeybosn L'Nn TOWN OF KINNICKINNIC nN 022-10P6-80-000 SM ER. m(�lm a&o...n IdA%�.,+, ei 'wr..nm.nw 09.28.18142B TANK INFORMATION 12 ELEVATIOI ATA IVPE MAMIFAGNRER,, . G CAPACITY STATION HI O EL I O.O S,O, 't W 1GXr JT + DofW,D c"malt G"cn9 YX` 7�j ZJ At M Ou MAI .�1N. 88 BIEp 5ex,' k.l 7.56 of k 25 5NO AN iw TANK SETBACK INFORMATION or cis. 16iR' f/..-5q P LFX6 TO WELL SLW. ina.0 ROAD On yy I�. �I. 4pec "nnm RS.,M.n xam, P'Y Pqe ml sawn PUMPISIPHON INFORMATION Gw M.wuwm 6C7U T15 o.mene 1 G-F55 sl cover�brdaw ILb. HB 05 linermsi6.7 93. o 809 Fna�TO, 5y,w lrz mn� o,�, mww �8 ffidwripal mnlo l of O, , I P" Is nNow P.m RYeIII SYSTEM BLGG l 05 LL ByV ANE i ON 0i Iff. xx..,e.. P�n'88.6t'p.2,. spa�"P� z, .Ni'P'%91 voral >�,n miss — — OUiLCUVEK . Pnuun Svneme onM una oru9na 5nwm.Onlr r v R4q Z.n Ens.,>f2" �.qnP enn ✓Yt Po..>IL" .. MUNAI =c�c Y.. , No COMMENTS: Ilnduae cm. elav,p.nnee persona praxnl. Nc l (""mall", aI J�/ J 8�. In•ec n IN I IAU SM o,amglan•WT &Ostr _HOC<µ1p%n iwSu�T4Qf(I/12� f �bF`�IrIW'w. 3 r Bldg mover covle-LIOWyz N Gx�si>T� PowiS a�iAn1BP.,-1 as rPC tom. Plan ,eat IP Zo 7� .� l ei3GS a." noon, ason?ene 1lnbime,6x Nn 5aoa„p(R=,P„ .Nr N t1LU�a�a,1_ ,dal ItT,C��F . '' S=rIlsulunpe0maon St Crow 1W N1NiryM Aro PO g 71M ronom RmUNummlwt�e�nrflM Fgcel JUL 15���� NadWa.VA W701_11M L cSitinitar.ftEmitjkpp1icatI wmer vssntlw�. nam oTzool3s&c�M NNae.R.'m�m:m. 1m arlr wwq��111eN.` vm name..ormrsmummulre.em®r me i�rv.. sMn� �prar:mi.'.,.raww, m. 1. <n..m�r:m"r II'�D CouleeTra) r.A IkiatimTram:rIn-vx.r.PrmAul'ammlm William & Judith Snoe bos 022-102681 -0 me ss mv.rnra..ImO S. 1170 Coulee Trail CML MN �.A M Asxixn k Coy, sm¢ evem. mmexwh, Roberts.W 51023 e7 r 2B " ¢naF,,0 N k d'1}peol NINE" r.k..kA Wvl.pplyl / v SUL4vumxwe X Imi F".4 xxv d-xumcr Of Ms 3aa,���e������pp L• ❑wduCommemal rex„M ❑c,e.M ur ❑9m OwN-4vnkxs ❑Waaaear aTm ,wnlxaex� Nunhr 1 ' a 90' R4 0.de IRiranrPemu. ,cnuklert um 9lhpplk.Ere1 ❑xe. sy.um Xl km•�s.+em ❑i..Imemrx.a�rerw k,rl.amn,Ianr ❑uIM,Mmmw�amL...ImsrwmrwRkr ❑v.m,I�Raew ❑ve„r.. w.,,m ❑rF.re•wvl,m,ee ❑rvneer�.,wa�ox.. v,..A,n�m�Irv.me.�o.:. u..a ry Try erowrs Re,mml .ewm..: ❑xo.v.ow.eal.A...w ❑Fa.�.,w l.rlmw 9A.r..+. ❑rwowe_ aI ❑Mow«.. or....x.w .um.r.wmx ❑xwalM*w ❑ru..e�w-Ir.mv.,..m m.mmm ❑m.ew�.ee.werwm.l__.. V. .mvr...m.MA... remmwmo wIx«:,.mre .Imm.n .v.,=I .�eeoo o yxwwxao-n :>*m F� 450 .50N ��^xw 900/ 9390 PdYbk Mis ✓ $ p Tm r.wa F J x 8 a 6 i=«viw.vir 10� 1emr u�v 7M =r NL Ru rMl sYmm'-Lu.mr gvgmve _ v�.n Mr iKi Knudtsnn 5 43rv� 6514)M1173] Jeulsmatan. sw, Op CM) 927 1Wh 8t Roberts VA W23 vm. Cam m. n,"t eo. __ roc S. ,�^mm,a 1 " ra.a7A �r �� 1X Ca m.k.Rluypmr. 3 [orJ.IhonJ 1,, s+>k ReoTewl .� iA " nkVia"It" gym. um�r a �! 1011WI tri pe pe nMerinW MuiumAr rnnma A�Mjw" 5� "Io.:w+imu:wQDhlfi� %X P' senmWm unn -irT.o A Sanitary Site Plan Far: W Wiam and Judith SimevenMn Nrvel in the NW 114 of the SFAA Sec.9 T25N-RISW Town ut I4nnickioak-SL Croiz Connry mim W4. Sew eo�/ry 0A Tmd wb ma Stm�e O.BIAw F sfiouu 0.m JpwAvepl?30.31 DovwTeak Mv-92 hb \ Anpmed/0's Po'An(»nde Nwbdlnpmvl Cell \wN Pbe Cwuwvrjl'xan BM 193.b' /// SYM1 ;ajv,vemW/n I% onus mMBaaee. SPS41 \8343nl Mc 8 93 M' Tevb4Arm bCnWn }Mll �\ -T+OR 9200' TartdArorroWm P2-200fr. M01190 -W-R&nnm It naneesma¢sW.Cwn.. fnnM7YOU � mu=s.we PUN RPPROVALE RU 201 Plan Reed PVVTSO7200135& SITE: Millar and Judith Un nboa mO Coulee Lan St, Calla County Town of Rmm[kmmc xw is - SE N-59-nRN-RUA 7-7 m"PROW3ur nvvmo bElr Ivrtry OF IworesaoxuseuvLCFs pmvox aP Ixousmy wWCEs tZA7i,fisi c w MNOMM OeuripWn Nt Ghwas CpnpwwnL ManWI-Ver 1.0, 5BP 38e mRtGr-4WGPD- 101154-P IN 03/07, R ol/lll Replacement-e6- to limiting frpor- Pressure DhtriMtt Component Manuel -Ver, EffluentFiger- MaintenamRe r9uimd lO SRo-30305-PIN O]/o1 R. 30/III The submittal described above has been refewed for conformance with applicable Wisconsin PdminlstrtlM Codes and Wisconsin Statutes The national has been CONOTIIONPLLY APPROVED The system is to be constructed and normal in sanMance wits the annosed appal plans and with any component manuals) elemental above The owner, as defined In chapter 101 Ofild, Wisconsin Statutes, is responsible Or compliance with an code requirements No reintegrate In Or work at plumbing In the star... Nes Necessity to do as by the (Assemm[per 5 fay 06. snit. MI electrical "Arms m and wiring shall meet M 316.Ml)la1 and Table 3 Mthe Pressure DestdbutlM COmpwent Mari There shall be no mass then 3%vMye drop In th n wiring to the pump prt the Wtlo Ekttrle Code. Ore must be teben m cet thedae wlume as epgwed in the plan design If the minimum Mlur length of a fingk ewNN meJUMUI flan dies M agree the proper rinse N,me, two separate floats mart be used. Ginn and ramwaH To.mole maNMy any leaex or dame oganl[matter man be raised up and mmoME. Out rain and ship by win to the ground and leisue.%shin. Avold operating equipnaar of the Chapter cell ilu. Nnxxsery, Same only tracked mulpmento during dry conditions, with minimal parses, to medd ,mmosmi prW to communion of tit dlmaml area, mete the mil It, Is...tent of The you to, depth W g Ireland. Samurai and co mpamv awes aal win rerun In reducing me Ins return Sammy or me poll. Pmpor Cell nwlnme [ontmr San M detxndnad by roIIMB a W Sample ONween tit haMi. N it rWC hmoa 4a man point Ind Me limns win toprtmrt H h numblex, sde preparatan [an ga[[eE. Nth WeN tin M m gepne, do non Mo[aad until M drka, ousluary Cari n be.baaM i me county "ere this Correct, Iuored in accordance with the resuiremenls of Le 14SAg, We, StaLL e Inspection of the private sewage system instalatlm b regaaed Arrangements for Inspection ahll be made with the dxlmxed county official in accordance with the pmmBions of Yc 14SAINI W S e A state appmaed eMuent nitern reouired Maintenance Information must be own to thrownerof the tank mindamine that armdn neanmg of the into armuum wherrovandurdtlikkallabactors owner Ratppntellhles I The current owner and each subsequent owner,,hall rerelve a copy of less liner Owners shall also reia copy W the appropriate operation and maintenance manuallsf and be responsible for ensutlq that POWITS is operated and mAnsined In auord,n,e with this chapter and the appmued management plan under SPS Sell n the emnuhla soil abmrmad, system or any tPos component loans manunmons,o ,to crone a health hazard, the property owner must follow the Contingency pun as described to the apparel plans The owner Is xanuble for submitting a maintenance %radiation report aaepude to the county for maintenance tracking purposes Report$Chun h,ubmmed at Innersole appropriate roll me comp.nmqu h utilized In the In granting this approved the UMibn of Industry Yrvlcx reserves the not in require manes or WhYn, should Conditions area making them nemsary M code terming a As per state staff 1011212). nothing in this eukw shall.ales. the designer of the mansiMllry for dmgmN a Safe bulMlng structure, Or ommu m Incolms, [oncemlM the [onxgnMmce may be made to me at the telephone number let" tral or at the address on the letterhead The above left addrpsee fbll pori a ma of the letter and the POW S management plan to the owner nd any others who are responsible for the mstallalbn, operation., maintenance of the Pwwrs Sincerely, CeC& RC[dn&44( CeCe(EHRabeth) Rull Wastewater Speclalkt/POWiS Plan Shaul ONlslon of Industry Services 608)400 3186 ellzabeth.rudniclawlstnncirdsov RESIDENTIAL AT -GRADE DESIGN RuautlrW-Slomng 5/N INDEX AND TITLE SHEET Prgect WALam AM Ju]pn 5no Wo ReW menl SWNry SyeMn Ow Willan SranSenaaa AWress 1170G "Tretl LegalDxcq%on Pamalln Me NWlMMNa5ElJ4 a 9TO8N-R18W Tw M p Klnnkk,n= County 51 Gpa suwwe Name No LWNo No QYVURyONALLP IMer a11M Page 1 APPROVED Cakulawne Paga3 U®r OF Lrtn AND worE"loNu smwcee A"rado Ere nge Pope 0M1moflNWalevstAVIRa Lareree RM OOe Wnh Pega4 swla Mne Page 5 Ll/!y����� �I� me�emenl AC Jgency pan Page6 e( zw� Punm arve 8[Pc( $ PW7 Pm Plan Page8 Desq"r KoRRE Sbmr 91% LK %ANumw Dam grer l57S 7 Sg 1 (/�/l i l _ Pnme Numner 11"53-2U4 JS_1 care 0e 27= Alyro]e CwnpuxN N"i%41 SO brPOWiS SBP10964P (N 0Y011, "Pm $SYMP PWyIgn pB 0.apiWPreaWR datlGrym NelapYbSi SA6 (01@I)wtl PmauN dNrtuppi LanpuiaN r4aW Vs ] D $BPI W110.P IH OLOt((F (.rp,! Nr 70(QLT Pp 1 of 8 PRESSURIZED AT -GRADE DESIGN At9ratle Design Werk -6bgrq Sita no aM Sb We EMry if or cl AN Ragenealo'commemaroESM1naNE watewatar n! t91 Nslgn wasreweter fow IGO) %San note Connor kev aelnx beret (m)Dean to Ilmnrrp factor In) In si soil application me(gossal Distributions (tanl muNon t+ ur zl t mane, unai rele iodift la,po LrMer loasrng rate 9llaat 10.0o Max affix ogmn rem la 10 M a eXmwe wins pemnnes OU 9] 00 AgaragaR banns It11 un Distribution Nra Entry note) Ceara IXBM leteM mnrrocom NumGa'01161enbOrificesiM rs(in)eg 035 ,��bi Examined wi spsnrg(it) FOrmmn aani (in) Famemem fill vi city(Wsn) Dngrnr must at e Mewal awe es Sysem seen (la x 13 instant lm(n( FmLon hss (X( lnirp Filer Lines n) Total oyromc news (a) me yarn Area rea== aln Erarn NOki porn Are lebrYa et n I pamli N 130 Forcemain EninNck(gN) R 5 5x Lkanl wd wi tip) BSS Minimum son eaume("0 3] ] System aemens Ippn) GaWnsllrlen Gk iaerloptional) Took Tank Contacts (pall Too' Working Load OeIMn In) GWn (enter reauk in cax Wa) Transient Tank Inbmulon lout $ tic tank opwry gall Winner ConnreM ManWxturar Effluent Flllw lnlmnstian Dose Tank lnfarmslion Iii Los lFftr manufacturer )W.e Wntanx capedry l9eD pLi36 Fair mcnel numaer 00.s Doke Wk values (III WlwrLarcrNe MenuM1CNnr tmpct Will and JulgM Sncayen Wa Rapake nanl Sane SKem Tianswitakin Hummer Pvi a AT -GRADE PLAN VIEW rr T p /� lee mxnneneoaalxxrsun aJMM R i TRIESR W + CR Ip DR lMft EIt + Ln a 8 � WAaBMI a� caa O= Tmel 59na9aa Oil A 9 B tln e. ey l 1 AT GRADE CROSS SECTION SYnMeac lame mVer 983JR Eaaaad p�ade seem win,93 W R • `!!f p nnwn qpe al aggregate Ke E Randmnadan B3 i0R C A _ as IMn D -� ' 12 in mpaau aM aoewll er aggregate and apertd In roes Mi �r 6 in e93reAed eelcw PWal, and i in si gape Pact N111am and JWiM Snwyanpaa Repelcement Sanllery Spu m Tranaecimn Numaer Ppa 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram -center Conne wn Label BpecMCMon• 0158 Onfice ddemder(M) Center L9bral ponnecmn doing 1 1090rMcs speOng(RI t Num[erlebre6 80 onficeaMMrel P 8866 Labral=ng rft) ]xI Lai tl�u.M1erga lab l9P'^) x. Lelerel Ewrzter IN) x oo F 2 erne aumeler (le) ]xx Sys au.Mge rate ggpm 9000 Famnun L"M lb a n TON(n) Typb•1 Pump ClrenlEw LaywA arnw.e..xer. m.v.m WIMMNba tmom,w4 wbn n Fwluq doomed � u neenrwun woe Ir f i{wwef�F Ebow Nn sm3me ' EGXGwAC nmuu y-- e ibn In llaa 22 oe ax13 M 20 406 ex 855 10.0 =0 JIo 15oa ww� o n Pamp Sw kn euww to arrow B�sn O PmpM ufne. � 819x n Pump manelamerer Tm I1MmMre norm odal numer Pump menu nmex TmIR- aarm mane nnfer Prq¢l. Willem and JUEIM Snoeyendos Repalcmmnl SanNry Syebm Transacbmn Numner Page 4 of 8 Maintenance an Operation Scifcation Serv¢eP�else Na Pw.ers SanAaO Patna ilS305 PoWTS R 4tNa Name 51 Cocoa Loun LaM Selma Pams ]1SJ661660 Snbm Fare so Lwd ftmm M Owen Flow Paaa a50 9W MUMuminfluent ParMe S¢a to In Essentialist -A= Jlq gpl Maamum BWS 40 npM1 Sea¢ Tare CaPKlly 10N 0 Mnmum T55 to na l Me AMa,plaa Cdnhponenl91ze etp0 a' Mnrmum FOO w myL Type of shaped x Omesh Maumum Foal COYldrn et a cIW1CO mL More and Pump Tan Effluent Add Pump and Connote AJam Pressure system Moore Olney tl andFor servo owe eal 3 Ins cl n amtl natty onsee irars seal oruwm J sndrw mM mono wa LatenN shook! W hushed and premium moval assay 15 torshat Inspect Car pOrding BM see Mlanslgmoue Conanructlen and W is ndsnl 1 OEwnauon pipes are sb11M aM materials wnb,m Ed Table SPS Me W 1, have a wa4dpht up, and are 5aarod In as shown m IM abrade Camaraderie manial 2 Depersal Call aggrryeb Conforms to SPS W M (6)(1. Us Adm Cape J All mealy and massure gPing matarass Conform b Na equearnamper inSPS JSs "a Mon Coe a Titans of no Cesar area is a[Copl mnre d seem rndid prompt or Chiral Pk%M 5 Trm at game s uCwo and omen dnN,nrsl erns sand ha seeded atl muHwd b prevent M4 eo4dh and help mature post penearaMn 6 Areas Comm 15 adds of the dWnEMq¢ ICe we Ee pdttM1d M1dn Compassion qll dnr mnsWtlun damns xe n pr lM at9ra]d tu'nWrwM manual SRDnpB51 P (N 0107) Fisher ......M45 ........ Lace V 6A Darpmr slam —Threaded CbanM Smnkmr Valve BmrPep of ME VOW Material `ag Seeep 90 da TwV 93 50 it -0egree ems Same ommeteras LamrM Project Vallsim and Judith SrweyenWl Repapemenr Mnstsq btided Tnnucaon Numaer Page 5 of A At-Sntle System Menegament Plan hnwM b 9Po 383 ,WY. Mm. Code �¢ WA4'Wnmm atgbo body) 4YEc w[utroado nobirmmn. nneeded neCbnwnM WnuYY.r vO6m101n IH dl.agl Add ow v Mupznr nmmmenl NMYermNnpwn Spy N1 )]. Win MnrCWe oWnh N. YMSA mwa no bTru.Mu Famous "Mi rnbuwbuu An r IM.8 W.m Motor to prp.ewmmnra or.n.mnm old Andy re.try. It m,w�n.nd oh 201 N tor Seas CAM rm.. �at.p gq Asu..glicor wf wwi new annu Ted Wed Mw w11 ads tans n'emsaryit serand rro • anon onews opanrm To, Y At Yw And AM 11,I)AL aMing son Mithat mry 54gno a are Ani to rhume YM II let n prom in m. p wM trclo M Me "itW.n+utl n ne wen n.urv.at a coot out card i neon Man n.w.Ymm mry.new. wi Mn n.n mani mnhn.os. aborm Man � Aek "I Moser as ost Arm Ani Map n I hI Intent At Asset Inn Maren A fla, barst Assets' 1 3 11. 11�1 niandonly It by wnor Andooded A no I M do A M net WM�e� Mowrd mem. a backaly 1AMIcki "an Maw .hW Adw+,.o�t rods...<wn pane. w. Mad per ww n.Md.d do L Y...w As A. of cpn.rr.rn a",TIM M WMInuNIYW.,W W.epeou er Am wn.wry) Me, AM Swo � wad A,d,, m.e,ry Mat gervm Jan MnrmdAxrnnmee a.nin rM nn,nwnn+nwNW Wrwda..vnery m�i avii a M.Wdw no, me al-iw W .unps�xlndnM1wp.rrweM Lr.Rdw Nnb reds Yur. wmrWv'n hW A.M.d Wrim wr4r.dm W1.ep nu.melOYrbripwryrmw.n mtmn Mandis An grodabm«Ma 11 AL'i Arm bass no wAanda.w mart .vnI"tt:]rW rrp1 i lyrrgt ro Among gINPn WmMy , I dosrc .ra.IWrvbnpM1n�Y.dNn uNndMT.I AM Among m.mwn a.PM sonsfient is, ousbasyn rc was« the Ad d east u.r.d add .. r.dominant land Anne rd.dw q.,M, of Made at Asset wr same Amed on seelem way, w,,.Mier,.«we<aorcrdpade°eW n radaysMi. In..nd1e opera rwrpewp .r.p,uu...,.ei.,off.dre An Aredwpaw hi laffor, «. ..n. aAX, a,, dons nooffem e cnr, ..rn.. m.n,em. nr«p.. m.... m r,.ntromynt w. M.. .reper an.Wd eat n.,n. m..eY,h. nr„pn..daOne Anww.Ye., rue And or Fespari win A on pi ul the same or ni _ ,��: nOut a wneeded An it its present v+AsInstead nsNo sac Ma m'WUWeM W W Additional r,.N .vq nwrmrpvunn an named mv.aary to dead days, Ide 5 Oj the ado n mr the none. YYprma nw¢.r of ymi pbMS dµunr aw uro g r Proecf Willem eM Judith SweynnOos F Transaction NumMr pabil l8 �(aj GOUtDS PUMPS Submersible Effluent Pump 3871 LPo O •IMM �°3 �MWE6bebNkN �4�. �1�V�'-� AOfNLT 116n110 •iTR m,W Waabt. /ub � ��M9iT1T `ia1�YYJ.On •1W/OlysvnV melenvA4Ytl.Y ,Mb GV vm lRa-F I Mbim4 •wmemt, w.e.s,masan bmwenaa�veda. T -c'u''I '� a�roYamePmRam ma9�.�Jrmiil. r�i. •rb sasnWill ee...rmr+p.mm�apae ilalY'ligle rarewm.im+nni •ri.m°s�wrsy ruswes �mwn.urn�..w� w °.e�m ,sl01MpW:nmrcp¢ ,ry♦goprsMeam •draww •iptl llYwti�pwlllt pnpWwabmNisvl wea.. imaaa. ixmlwsr°urt 'a"Oof^^ •�asa� rwam zi a os.eua� rm �mo.n g9 m 9 •n�sa �mii IMIl amu l - aww,.a.awn m.w •easyyry�osw APIy ' � nSVvbN B]16 a ° w G.W"I e°we�l'M o ehrst •IwamY lOXv � Ytlue Yqh Fo l 51101YaNllrwpaq 9awlinr9 �o u I - fe ww Ntrrpr Iv.M vwooft ti rwan Goulds Flu P m m� <&MindusMes ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/buyer William Snoeyenbos Mailing Address Property Address 1170 Coulee Trail (verification retyuml than Planning a ]nntne apttnan fwrew comuunwo 1 City/StiteRoberts, Wit Parfet IdenufieattonNorther 022-1026-80-000 LEGAL DESCRIPTION Propeary Location NW, SE,,,See.9 T28N R18 w,TnWnnr Kinnickinnic Subdivision Loth CerbDM Survey Map k , Volume , Page a Warranty IntendI InI1If (before 2007)Volume �, PageW Lilo -gill Spa nauucorwQn Lot lines mmtteWle Oraono hunroper now and nwlmnlame of you aeptic.yIOm could result to Its pmannol l:,Ime to handle we[¢e, Ptupm maimpounine Intel, of pumping rim the ssylie lank cvety loven Yeats or scone. if headed, bye Lamed pumlue What You put Into We sys4m canORct the follow of tle scion tanker apinpoint in the wudlsp te nsal sy9emw . Ower maintenance a rpmulAlma ant spenl0.M nSSPS My 5E(I) and in Chapter 1E- St Cmlx County Samtvy Ordhurce On property oath a8teestoruhmwa St Croix County Planning B Zoning Oefxnmenl aapplication fort etgad by the ov er and by a easier ponnx.Ire,mrettl coconut plumber, tnded plucr or a lice tl pumper emotions that the onatte tto dlpSne l iydeis In poor nperannB condition andtor(.) ItalyItalyppoi An! pungingllfn¢ewryl. the an aunk is IetMn IO full nk udg, 1/w[, Use wd,mlioW hove red din endere rtquttarcnts and agree to mmam flue prosper manger drynvl syslam wN Ne standards an fond, herein, as Al by the apartment of Safety Mtl Pmfeasmnal Swine and the, D r al eni of Net" Roourtec Stateor Wlttonam nsngcauon unmBlN,130"pofffic Wy=e ,rim maple oumplaW and rtlumW wWCSe Cror CounpY Pluming S Y^'nm81)epwnem w,lbm Yn dsyx ofpbc Ilr,x Yrr[W�inbon date I/wewnlfyaMltlbbkmrnu no NU Lrcmateweto Ne b[nofvy/omkvvwlMge 1/wo rnYuv Nv own[rIv)vlpM ProPerry tlarrlhdrNae. by vnlw of aoty t4d rtvuNM,v Register of fJeeds Office umbr of brdr m3 SIGNATURE OP PPLIC' T(S) DATE "'Any translation that is mivMreseoW my result in the outlawry pertmt berg revokM by the Planning B bact Cepanment "' Iw11Me wM this application a rteaNd wemmy t4cd from Ne torpor of reeds Once rind a copy of the ttnified survey crap R reference is red[ r the Antonio drcd naii ability 1Mmtin ppil InBq PraMli a 1 _ a..lmalw9ry SOIL G I "0 j !i►Cs1-a9 0 , a oiiozo aovm¢sMT6R6].SWq.1WnCcy d IxN6biW3 a.®IIo _ n1.... 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