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�:.-;,n,ic• county p '/
<br /> V;, Industry Services Division U ti Nn K7r
<br /> }f. 0 1400 E Washington Ave >animry l'mni)Nnlnhr unb,l illedinby Cog
<br /> `; p I'I P.O. BOx 7162
<br /> 1 Sw MWl 53707-7162
<br /> Sanitary Permit Application 'N1Crrl 1E1ionNwukf
<br /> In.0
<br /> find, dh SIPS 381. 1( ) VVi, Adni,c l 1 IbOn,houl in h 'pWlmts tl unit
<br /> i3 nq - Ip'ono nnmi - g ,y lxm,t Nte�,\ppR-nup tnr Rr:uta W10\\ Svc subnllult• 'n""Addnss(I'dit:a al um Ys'tdd Gds
<br /> 111,I Icpa„nan of S'nfety and 1'n't—imml Savior. Pemmul iMbm,:vion Yon Pm,9dc ntay'U anal Ibr serontUry 7/ 39
<br /> lun d nnlance lith We l'd,acv Law.a. I5 W1111 m..Stau. / J n
<br /> ,\)edieafioinn lnformntion-1'lexw Print,\Il lnhv nation N< p/r.n L/G M1
<br /> Pmleny 0—l',s N:mm Pamel b
<br /> trona tcQ �e(' ^ , � 07-ew 2-4o-/b-o9.4-oN-loo-Duo 0
<br /> I•mlxny uwnat'z Mailing,\ddans hop yImaron
<br /> /7Nd ac� <.&p X-eGnn�Lnt ,J
<br /> city.Sesta cpewle Phone Suis n $E S. SE '/., Bertin. /
<br /> /n/V Ssi/b 6/J. v/8'/ — rimlcn
<br /> i 4p �: R c
<br /> 11.'1'cpr ul Building(,fork nll font applrl Int w
<br /> �I I nr2I'un111y Dwelling-Ntnm,m ufnahnon, Abtliviciun Nan.
<br /> Blpck u
<br /> ❑Public.Cam,,.rclal-Drscdlx usa
<br /> ❑atv of
<br /> ❑Sate Gwnctl=lksdbe use ('SNI Number ❑ 1911.16,nl'
<br /> 9 nnnnr Oa/cl. + d
<br /> u1.1,profrrrmif: (Cheaknal<onrboannllne,\. Cnmplrlefnrl)ifa,licnmr) 6 t
<br /> A, YNew Systcu, ❑ lllWn,.lnent Sv,,-. ❑Tlewnant/Holdng'I;ak erpwecmemonly ❑ Od,cl.Aludlretlion in f_,iuing System lc,pladn
<br /> If. C1I'anN a�ne„nl ❑ Permit nv, inn ❑Change of Phm,h 11Perna rnnnfr:o New Lia Pre,ion,Penna N'u nI,[t:md nine lseual
<br /> Before L,paatron Oo nor
<br /> IV.'I line of 13O\\"1'S Ssstem:Colnpnnon/1)"ire: (Check all it,;,,n,ph)
<br /> XNnn.rns....—I In-llmmnd 111........ <d InGround ❑ A,G.de ❑ M—nd Ila in. ,, da.tbi,—I ❑ Mono]124 in of,dd.hIv sail
<br /> 01Ini,im,lank ❑Oth,r nisR'Ar n'rnitlnVlainl ❑P,nrtuunen)Dn ice P',pluinl
<br /> v. Dispersal/rreatmunf Arcs In o-dunion:
<br /> Dv[ign Flow Igpol D[sig1,Soil A,dicuion Itanspd,ll nislcr,el An-a Itaouirad(+1) Dizryssal,Aan I'rory,ad(10 Splan Elcm6nn
<br /> 30
<br /> o 1 . -f 1 6do (6
<br /> \•I.'rnnk Info co"u,in lural ant Nlwulgcwnr
<br /> cellons Gallon anal I
<br /> cv lanws I:at ...r.... - _
<br /> Xpra nt umnlnX row X00 800 / S/L9w✓ X _ _
<br /> weo_cmom[,
<br /> \'11.Respotsibilifs Stnlrmrnt- I.fhnund.nigned.aaunm rnp,mibilltr rue inaallaann of the POWI'S,hu n On,xtmd,nl plain.
<br /> Phoob, ,N:unc IPtinO Planbur'z Sipnawe NII'lhll'RS N'mnhr Business Mon,N,Imlkr
<br /> Pllmnhr Addv,(Sheat.On,Sate.]ip CodO
<br /> ,)77Ga �,..y .3s we-L51-� &,-j S/1853
<br /> VIII.CounfdDr arltnrnt u,c Ont,
<br /> Ad,... 1 ❑ id,q,prm adYc,mit Fee I):nc lamU Innt S
<br /> ncmei�n:nu¢
<br /> ❑onnn aca.nnrrDetd,I /`-�6' 3 ning Age
<br /> IS.C.nditions of App...:.UR,mi n,far Dnappr.,al
<br /> AD EC E VEn�
<br /> \na[w In mptetey:aro furl meenmLnnt,ntM1eftn nr ,nn npaPernnt le,.thae Xlr_,Ilin[M1
<br /> BURNETT COUNTY
<br /> SDD-4395(80313) ZONING
<br />
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