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ON COMPUTER/SCANNED <br /> cnnmr3aa.✓ <br /> si �s s Industry Services Division N{ <br /> i/4}'/ d` 1400 E Washington Ave Solum,Permit Norma . .....ed in by L'o.l <br /> S- <br /> -., P. Y-I P.O.Box 7162 <br /> "i y IS x^i Madison,Wl 53707-7162 <br /> Tmnaainn NmnM <br /> Sanitary Permit Application <br /> man lial with SPS 3S3 I( ) 0',. 11 Core, l Ith kno to 0 pp pial 'overmarmal unit <br /> .rcymrJl to thanninga lallorINl 1 Son, VPII 't' I "ft mal ltl0lS are- b '. It Io"L�an"(art coari ailing zdJrca <br /> ml <br /> the IhP' t t o(Salu'ty a orcad anal A Ponal i l r.u v a prove oar ust <br /> No a I n <br /> vo e't0 7,f <br /> Perot., <br /> in cemcare,with the Pd.vcv Law,, 15PgI Nod.Sane <br /> lApplication lication Information-Please Print,\II Information <br /> fritter,owner'.Name 07-106Y-�' tit-S�fee/ <br /> N^r /< w /1 ca/f loo <br /> per,ar (hands Moling AnalYmlcny L«aeon <br /> /9.f-d Jen /</�t S WE Giol.Lnl! <br /> Cltr.state zip cane Tho.,Nnlnlzr y I, Section la <br /> —'(circle noel <br /> [3tFh�-1 N'1 /V SSO// l' 35 N: R�F.o� <br /> IL I line of Bnuaing(cheek all that app.)) Lit e <br /> rrff Inv: late.Name <br /> y� Iorn_Gmnily Dwelling-Nmnler of Bedrimm JI <br /> Mort,a <br /> ❑PublioCommemial-Descone,Ike 1 ❑Ciry of <br /> csm Numl+tt ❑ \':.loge of <br /> ❑stutc rbvncd-UcscriM the <br /> V W � � H 0 f,.w„rf <br /> I I1.'1)pe of Permit. (Check onk one Ira\oo line A. Complete line B it applicable) <br /> A19New l"tan ❑ Replacanem5yners ❑'rtcmmunvunlding rank Repmcemea'rally ❑ tatbm NJ ati,anorsC sting s,stem(cxpinin) <br /> H. ❑ Penn.Renewal ❑ rerun Rev+a.nn ❑c'nanga nrrw+neer Olen+irrnnmcnn New <br /> List Pro;nn,Peron Nmmtur mal Dare lamed <br /> Ber tC Fx,ral I owner <br /> I\'.'I'c cof l'U\\"r55csn•mlCnm o rnl/Ilcyice: cheek all phot apple) <br /> Non-Pre—notal In Ground ❑ vrc.. 11nnn-Ground ❑ Atcrade ❑hmard>24ur efauilable oil ❑\LuM<24 io llfluarble Sell <br /> ❑ Holding Tank ❑Other Uislwmal Compnnem(explain) ❑I'rceeatment lkviee(explain) <br /> V.Itis crsahn reals car Area Information: <br /> Fkago Flow LaIll Ikaign Sri.A,plication Ratcgral DisperaaL\nnRyuimJ lsp Dispersal.\rca Ymry+H(.0 SYsmm Elevation <br /> 340 3 Goo (omD 4d S <br /> NA. Lack Info Cupaany it 'alto not hl:nmf ceinr <br /> Gnllnns Gullnns Unity - - <br /> ]on ranks I:aains:cols _ F <br /> -V - <br /> ......m Hewn, a.F 730 7Sa / 4/r vf�i <br /> Doom'CMmh+ <br /> \'ll. Respo r ihilFa Stmrment- L the undersita ed....nn+r«rpon.ihilitr,for imullmian of the PO\\TS than.on the mmched Plans. <br /> P1....ber'e Nmne(Print) Plamhers Soprano, hlYlhll'RS Number Rusin...Phone Nmi <br /> 7/r-ISG-ell%r <br /> Planta',AJdrcss(Sv t City.Sone.Zip C'a:lel <br /> 77661 /tea- 3S W'�-sfr� Wi ��893 <br /> VIII.County/De arttnent Ilse Onix <br /> �ApprovN ❑ tanor Prow<tl Panni.Fee Uate lxaueA Iswing Agem Signature <br /> ❑G..nerciam ac ti,r Denial <br /> IY.Conditions oL\pp...hUReasons for Dmapprm al <br /> 7-V-/41 ->./LEUISET� Copy of PLat/fySlE� D6S/4/� :P.EC/f�� �I, � �5��1� <br /> h <br /> unto to romlve pLm for the..vam andImmino the Counts on opo,ma 1—thatamvli Lef ln.ta <br /> BURNETT COUNTY <br /> S0U-9398(1auu) ZONING <br />