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ON COMPUTER/SCANNED
<br /> —� Cot my
<br /> " Industry Services Division (3 N.Y h e 11
<br /> ;ny 1) ?` 1400 E Washington Avc ca nn y Penn l Na a b.rp t fu n in by Ce_I
<br /> t\ P 1'f P.O. Dox]102
<br /> S7 ^a Madison,WI 53707-7162 S(n6897
<br /> Sanitary Permit Application Staae1lar—tionNa1111mer
<br /> I auaNaer-c hM1 S 1393-a'1./Vis.Adre,rode,%uhn inn arms mnaa to the eppmprai go-mmental uaait 2 37697/
<br /> s qhat p- t obml 6 2,"rue,penny A n, A1,11iloilan true,larsaat, aw IPOWTS ate alb It Itl Pn,et Addles,- 1fillneent then readingaddi
<br /> the Depelftirent oryi end Prdaujani Serl i asini ynu pramde nay bc teal fur seconder, 7b7v
<br /> ani In o.duvacutb the Value,La 15.041 UI nl.Stas, Af. (3ai5 L14 17e)
<br /> 1. Apidilthi.l. lnlarta inn-Plearse heir,All lnfnrmstion
<br /> [I....ny owner.Vann° Parl Y o�-018-z-39-✓6-r(--g
<br /> Z,br f A..je
<br /> X4-000– 01!/00
<br /> Ym�nY Ownai.Meiling Addac.. I'mperty Lochlnn
<br /> Yey Y FYcmOr f ,Qae Go,tLo(—
<br /> (.I',lien,
<br /> otChr.stam /hp( he Phi Nardi 45F 5aJ seedna ((�
<br /> /^ a SSva! 6iA Yis Sii 3mlean<1
<br /> _
<br /> IL Type of Building(check all that apply) Karp T 35 N; it/ hare
<br /> 1 nr3 Family D.dling-NwnberoD3.rlmona� 4lmdivision Nome
<br /> /lock N
<br /> -❑ranhecnamtadal-Dc—he U.e ❑ City of
<br /> Stair owned-D....dy i eSMFmmaer ❑ ,Magyar
<br /> f$'fowa af_/n«H e..
<br /> Ill.'1'ypeof Permit (chrrk only onehoa on line A. Congaletrline It fapplieanle)
<br /> A New Sill-, ❑ Repmminenr sryaeln ❑'GIDInu,1VIInW ng Tank rzepmrementonlr ❑oaecr Meehilmnnm l khns Spmm[exk1 im
<br /> B, ❑ remdr Renewal El Penn Rev z an ❑ ensu f rumen.. ❑Pcmal 1,i nsftM New Lar iPennd Nanmer and Date laxaed
<br /> trial,Ilrpindon 0--
<br /> D%% r%he of PORTS Sastem/Com o ent/Dericc (Check all that a a k)
<br /> ❑ San-Pac.wtimd In-t mand El Pi Inrmned E] Al ®Mmmd_24 in.ofsaiuble.ail ❑ hlound<24 in.M tau ,ii i
<br /> ❑ Ilommg Tank ❑Other Dap„s4t Compormte.pmr) ❑Pmeaan.rot 1),,av e,pinin)
<br /> V. Dis ter:alrrreatmem Arra Infornmtion:
<br /> Dnlu1 Plmv(gpd) Design Sail Application hasp D..Pemal dren Re4airrd fs0 Dispelml Amu I'mtwxed tsp Syatan Elevmant
<br /> m0 . 17 I 3ec
<br /> VI.Tank Iof. Capacity is I.,uI Pref Nianqu umr
<br /> Gullan GIIIIIII Unit
<br /> 1-Tni Feua 1,"Ilk,
<br /> sapdeon irlemsnen, 7_5"0 7Jb
<br /> oa,machanmt S 0 3a0
<br /> VII.Reeponsinial,statement- ,,the und...iuned.ar.ame rewponabuin_ far inrtanminn of the PORTS.non It 0"tine attached plum.
<br /> Vit bye Mar,(Pnn) Plummer's S."',... MP/11PRS Number Darin..Phone Nuance,
<br /> )z,i //, /Z, � L Y /� dlls8si cif X66-5 /s`>
<br /> I'lumher..Wdns.(Saad.City.Sm¢.zip Code)
<br /> ,477e of3— i'15Y.�
<br /> Vill.CoaatWDn
<br /> r ram tan Ilsr Unly
<br /> Appce,cd ❑ on,appmvrA 1, 1,Fee Dene lx.neA I—Ing Agent Si�nam�
<br /> s 7S 00
<br /> ❑owneraiyen Rican r Denial �i'/y/y'
<br /> IX..Contlitions/of ApprovaRKeavons for Dkapproval /
<br /> 7 vo0aa,fj `iµ( / /thi Aifckn6eel Y/0(1 WGt{ d+ �ru�:✓aM®�srf /0"4On '111^^'t11r__nr M�.fLJ.a
<br /> Y ///uh�d/ r✓ f./1j4/C Al0/^fOu,fY/ is .{V/6✓f. D �V�� U L7
<br /> Annah to—pi-plum runhe Hymen and rah-m the Cuu nil snn un p¢yer nm len shun 81¢,t I Int ac MAX 14 ti 14
<br /> G57/Gl-a6
<br /> Sill)6398(100113) BURNETT COUNTY
<br /> ZONING
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