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_-_ __ _... -�. .. - Saud County <br /> jry I'crlNumhw(lo bu lillul t'n.l <br /> coir merceml.goV �� Sat'ety and Buildings Division <br /> 201 W. Washington Ave., P.O, Box 7162 <br /> isconsin Madison,WI 03707 102 V <br /> Dopartment of Commorco IL <br /> Stae'fraasaeliml Number <br /> Samt <br /> ta►y Permit Application � � U <br /> In accordance with s.Contin.83 21(2),Wis_Adia Coda si bon.von oj lal 01al¢1 the apps of, "l : c ramal __ _ <br /> unit is required prior to obtaining a sanitary permit. Note Applinmt l Grana for +I ltn nal IY)U P,oject Address(it dl llmcnt than Illi I::g:viffi,.y <br /> submitted to the D partmcat of Canunercc llclnlal lakolanllon yoll plovide may Iscd I'or . ua11J1 v ��� <br /> hlrAppheution Intorniut the 1 dvwy I uw s 15 U I ra) SI v - _ � 6 ('� <br /> Iatum Ilene lh int All-lnl'or mrtmn _ 1 <br /> -- <br /> It <br /> IraOwnu Nvn - / -PIowl/ Iueahnn <br /> c'i <br /> I lopuly Ownw s vlalling Address � 1 Y <br /> y List <br /> -1 <br /> -- - --- <br /> —City,State Zip Colic � I'honc Vunlhcl' r,l n, Section <br /> yps — r reit III <br /> N, It J � <br /> II. I ypc of Buildiag(check all thnl <br /> h 1 n Nnm <br /> hlie/Connue.Jc aI1111g. Number otltedmoms _ <br /> talo <br /> llo <br /> n I}Inek If — I, <br /> Describe Use Coy nl - <br /> __ <br /> LSM Nounhcl 1-1 village A <br /> ❑Smtc UwneJ Describe Ilse - —� � <br /> 'TRwn <br /> _ -_-_. ._-_ __ <br /> IIL'1'ypc of I el inn: (Check only one boy un line A. Complete lou 13 if apphcnblc) <br /> VLlIh:tlmm�ellold in 'fall:It taco ncN 011ie,Duly 011ie,Modiliuihun to F."tang S"t"n,(cx piano <br /> O New System K1(cplacentcal Syacm k <br /> DMI Is,ncd <br /> Iasi I Iwmtly Pennll Nn n bur Ind <br /> It Pcntlil venewal ❑ pen ut Itevlvnlo n Chance of I'lumbu III'xnnl'I uln.I'u v ' <br /> ..n <br /> Belorc tixpnmion nwu.r <br /> IV Iype of 1OWIS system/cnnglunrnt/Duacu (( heck all Ih It apply') <br /> KN1 n I'ressnnaud to Ground Ll I'Icns'aw"t l l G-pond �.1 AI-UI I. (� MounJ bl In ,-1 e unblo,oil 'vlouud--2A 111 Of.uitnhlc soil <br /> I'nnuumm�l Ucu c(expleln) <br /> ❑ III ldmkl o1k l lUfhcr Dlsp r-J('rang 1 1l(expl:un) <br /> V. Dlsllersal/Iledmcnt Aret hdorm tion -. <br /> s <br /> — —__ <br /> De""K.,I sw(pp,r) <br /> I71slgn Sad Appnc Itl m IL nu(Ip hl l I1 pu,. AIla Itcyl I1 1�A-' I opusul lsQi Sys 11 lov.11u111 <br /> f ( tl:d lum'n �((ol, I Inil l III) ) M/'da]c lul l V 6U y rLl, <br /> Nc 111k. � I. .IinX <br /> Lo <br /> _ / //tI _,/ N I I III <br /> sib r l l ll't lank M <br /> � r �GI[,)(� I �' ` ,(L: 1 4 <br /> VII. Responsibility Stateinenl- I,the undenlgned, .. 1e rvsPnnvbl bty Ing incl altalinn of the POW I IS shits n on the ttael I Walls -_ 1 <br /> - <br /> plun h is N u (Noll) Plunohu s Slfn Ilam MI'/MI RS Number Buvnese h) Nunilscl <br /> Ph A Idoev(Slrccl,Cay,Stale.Zip("de) <br /> Qh' �. L.- -�5'i:` erv.. Imo✓ _ y 7 _ . _. ___- _. <br /> VIII.CnunlylDtparlmud the Ont} A t I,natulc <br /> _. _. Isatin ill: g <br /> �- - I I'crnul Pis It,leeuc¢I n, <br /> bl Approved ��I DisapplovcU 1 � ✓qW�'��/� I <br /> �] Own I(ry a Rlason loo sa co <br /> Q <br /> _IX.Cnn(lilious of Apin'uv:d/12casans fr I)iUise ogsp rn vol // G <br /> U II <br /> III ILul.for tl pa land sl Ln nl Ihl ei q' 11y oil lcg1lln Itls.nalN 112II "le 'it"I' <br /> _ _ .-. .. <br /> S1tD-Gt)x(12. 111/119)Vohd thnl tl I/0) <br />