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C . , <br /> Safety and Buikfmgs Div"aloi, (sem <br /> p Y- 201 W-Wastmrgmn Ave.,P O-B.1162 5maary Permit Number Im be filletis br Co.) <br /> SPS, a+aai�n.wl 53767-7162 <br /> Sanitary Permit Application sm¢ha c a Number <br /> In acmcdane with SPS 333±1(_),Ws.Atlm.Coes mismimat aftAs fam m drapprgaiae�vmmmfv)unit <br /> rmweW pnmmobmiairgaaanamy pmmie Voc Apptliraim(mw toaeaY ovtW POWSS mes edm Projst Addr_s lif,iffiemdmnmailinsaJdress) <br /> tFe [hpamncnt of Safm'zM Pmfcsiasml5ervica Peorsml udamalmn}m prartle aoy R fwsmdary <br /> our ses la aeemdaoee svil6 dle - ? Met <br /> All t m Sm¢ y79D 6 �J) <br /> 1. A limtion 6dormalioa-Plena Privt All lalormatma 'f KQ <br /> 1'rnpcmOnn/-r's Name I Pas¢19 <br /> h ! TofGtG/� n,L�l52f / cz poo-o/iaw <br /> Propem Cheaic Mailing AAAress Pmpvry'i.omrian ' <br /> GI Tgtmn . N4t <br /> Cin.Sone 2iy Cade Plaac Number N6jY_5 '/., Section L, <br /> 'WLRSI ///N SS/O�j 65/- 57 77/S r-; N: R `eo�v? <br /> III..Type of Building(check all that apply) l-m= <br /> I(Ior?Family Dtvelline_Nuvoper of Bcdmono Subdivision Namc <br /> Sisk s <br /> ❑Publie/Commucvl-DeseJ4 Use <br /> ❑Cay of <br /> 0Sm1e Ownchl-D.s Ux CSM N�bc ❑ viaagear <br /> ;eF—o of <br /> III-Type¢f Pe.ft: (Check very ave bac ou Ifae A. Complete ave B ifaPWk'abie) <br /> A. ❑.''e.'S,tem XReplecemcre Szem QTiomaWlNNing T®k Relleeetnem Only ❑C)u—Matln..to E-sin¢5)ztcm(explain) <br /> a- ❑ Permit Rrnm_I ❑Pcsmit lh. on ❑eluo,;,efMmty ❑Hm¢ir rrasG mNea ',a, rives"on,"..bo ana lone'. <br /> I We c,'cenon Ovxr <br /> I I\'.Tr pe of PORTS Svslem/Com oaentl 'icn (Check v6 Beatapply) <br /> 'o NamPresuaedln eni (3Presm®tln-Grama ❑A.Gaade ❑Memufa 2<m.ofmi¢de mil ❑Mavtl e24inafsuicuo—il <br /> ❑fiaiding Tank ❑OtMr lkspersal Compoxm(acplain) - - ❑PrGmpau¢Devitt eemly=) <br /> i \'. Dis ersaUrreatmml Area lofornuotipn: <br /> I Dcsicn Flo,,(gpd) Dcsi¢a Soil A diction Racf_mdif) Ditpessal Area Rcyabd l#) Depvssl Are Pmµaed(� S)vem Elevation <br /> 3a 4 1P'76 1y2B T 5w/ DYis <br /> VI.Tank Info Capace,in Toul aaf Manufacturer <br /> Getkan Cwaors Uvm a - y a <br /> i:ea rsts Fiiviryrvb A <br /> cV - J <br /> 5cpicar l4ainL Tmrk � O ("} <br /> Dairq Chemet aD lv <br /> \'l1.Resfronsibiliry'SutemmB-1,We oaaers[,eq aasvme rtapv®ml'ier five imhnatioe Na4 POT\'i5 alw.on tnc avxncd plo..v <br /> Plu - Name(Pr nU Plumbe' Daae nl%MPRS Nmntee. 6ucros Phase Number <br /> o lb ' er _� Sl95L! !7/5 B66 70 <br /> Plvm4r's Aeeres(Strtn,Clty.Surc Z�PC ) <br /> 27220 T mf o r /�c! WeL",/w:s4,g 4 <br /> VIII.CoanI IDC artmcat[se Oaly <br /> Appmvztl �Dimppo.W l4maa Fee Dme! d Isuiog AgmSigve¢e <br /> S <br /> ❑oaaer c.ea Reama ra oeam <br /> 1\. Cnn Jitinns of APprovvVlieunns for Disapprool <br /> SYfltm w.«sf yetre:ita.,e..}j <br /> mwfi be nrprJ NPrM five ye - a.+af' <br /> G <br /> �fv.a meommem mamnri4+nvm xa aabemw u.ugnaw..amwam Bmnaaarea tt per'° JUN 1 8 2014 <br /> SBD4393(R. 1 I/11) BURNETT COUNTY <br /> ZONING <br />