Laserfiche WebLink
County <br /> Safety and Buildings Division <br /> 201 W.Washington Ave.,P.O.Bax 7162 Seniary Permit Number da be titled in by Co.I <br /> S p rvl Madison.WI 53707-7162 <br /> Sanitary Permit Application Side Tawsdnn Noland, <br /> In accortlance.vim SP5l332i2).tY¢.AEm.Code submisiun of Nafwm to tk aypropo�e�+rnu:r.-nal unu <br /> rc9vird Pnormobainirrga saniury pemaii Nde:Appiirninaf FwsasxumdPOWTSmsmrrtiaeam Pmjen AM Undn mast^;address) <br /> the Dcpanment of Safm'etW Prxfesio�ul Senicz. Persoml hJatrtwan yax prm'ide maf h usN for saeoMzry <br /> ,.,odds In acaaa.ede with Ne Prnta Law,s.15,04(IX.1 Stara 7Q V p / r /p /D/ <br /> I. Application Information-Please Print All tnform06atiou 7 fie / X <br /> Propcm Otwer' NamePte`• - <br /> /�IcrUr� g(j0� 3 } 6204 z 0z o0 <br /> Propeay 0.•^e:z Mail-ALdndress L/, Pmpmax <br /> y taxation <br /> 7Z,5-;? 1 ve / Umf Lott <br /> C'ry.Sate ��/N zip Code Phorc Nadide X. Y., Saawn <br /> )(-"/ e-f <br /> S/ � A/ 561 16-43 <br /> '0147 T 4o / <br /> N; R�hanclE on un' <br /> IT.Type of Bu ild ing(check all tha(apply) - <br /> 1 or'-Family Dwelling-Numizr of Bedrooms Subd—uni Name <br /> Block 5 <br /> ❑Pubiic[Commerclel-Describe Use <br /> ❑Chy xf <br /> ❑Sale Owned-Describe Use CSM Numhe, ❑VRlageor <br /> I:i(Teanof o jk--� <br /> 11LTypcxfPermit: (Checken,riueboxxnline A. ComPle�line Bifappprable)� _ -G E— <br /> A. ❑ Ne-S,,dem VReplacenienr S,¢ ❑Trot—oHnWfr.g Tank Repimeen.Only ❑UM Mxdinanon m Eazaira Sysrem(esplanu <br /> It. ❑ Permit Renewal C3Permit Revision C1 Change ofrivmlac ❑Prfri4 Tamf mNew Lm Pmtma Permit Number and Date iswed <br /> fklorc Cxpimbon Oamr <br /> IK I\pt or r01%7S Svs4+n/conaonenNDevier. fChe<k all tha4 a Iv <br /> �❑f Non-Pressunud 1,-GrourW ❑Rwudxed ldt,datd ❑AIGadc ❑MpaW>"a4 in ofsviaWemil ❑Mwnd�24inorsububle—1 <br /> 14 f1oWingrank ❑Odyer Dispersal Cmnpwxm(e.plu'n) ❑Prcbalmem Dcvia(ezp!ain) <br /> \'.Did enaVlreatmentAmalnformation: <br /> Desipd) Desien Sail Appiiation Rae(1d0 Dispersal Aro Requucd 1st) Dapersl Arta Rxpoud(sF) System Eldeawon <br /> wZoo <br /> \'l.Tank Into Capaary in Total eof Menufanurer <br /> Gallom Galiowc Unita <br /> Neu-ta�ka Fvai, <br /> �J <br /> sci is Hosing Tank <br /> uan'ebanher <br /> VI1.Responsibility Statement-1,the and—igneq szeme mponSbJiq-fer inadd3ofan ofthe MO •hewnoetheamatrcdpian- <br /> Plu 'r'e Name(Pring Plumper' Ane MFINHWi Notation, Business Phone Nnmber <br /> c 5(95�t7!5 B66 zo <br /> Plumber's Addres(sucq Ciry.Sam,ZipC ) - <br /> 27ZZo' <br /> V11L Coua I'm artmcnl Ode Only <br /> /Approved ❑Disapped pe'o'n f¢ Uate lsMtl hound,Agrnt Si. <br /> ❑Owner Gie'en Reason fm Denial <br /> IN-NNCronditIIrons of App1o1.LR.,b.1 for Doisapprnval,,y.y <br /> /r'IfI�11NIH Z� Se�6e.Lk /a N<� / Lot! rw P'N�I�Oh <br /> D EPr ! <br /> EOVE <br /> atiM meomnvrc of�ea rorrks>:rcm dew rabmnmrnr eoonty e>,h=n wpvn=.t�wnar t aaygjtyae 3 2013 <br /> SBD-6398(A 1 UI D BURVNI. ITT COUNN <br /> ZONING <br />