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<br /> Safety and Buildings Division (J r+vn {�{'
<br /> �p' -moi. `.' 201 W.Washington Ave_ P.O. Box 7,62 5unimrc rcmtit�umbcr lm be u l<J is by Co l
<br /> •_ �\S.P rl
<br /> Mad son WI 53707-7162
<br /> Su¢1 mnvdion Numnu
<br /> Sanitary permit Application
<br /> Inas J 'th Sl`S3X 1( ) \kis A LW h -s 1tti:l r m 'pp p _t 6 � tl 1
<br /> ma - dp oobw 'e '{ t M1t ,APPI' i t sl sou dPONrrSsubmittedito ['reject Address ofitier ttl wiling address)
<br /> the Ixp,n ne,1 nl Snl<t)and Pn kss inial Sen ,e. I,rsnnal-nmrmai on,nu prm'id,may h uxJ t J'r. 30/33
<br /> corJan¢with the Priv acv Lee.s. Ii pit X ml.Stens
<br /> 1. A )iic al ion I n form at in n-Plaine P ri n l A l l l n to nnvinn /"Mt✓'vw-C/A•» O
<br /> Property 0,mci s Name Parcel X ( /L3SS/S l
<br /> p�o3}d4 07 7,7S e
<br /> Pmpern-Uwcr's tdbilin¢Address Property LowOon
<br /> 6 634 E 54eA co,ILou
<br /> Cur,Some zip Core Phone number t.. s Sonoma 3S
<br /> - (
<br /> [/no Laltrl iiN S:5-01 e4 T ell cirdc oMh
<br /> �: R_((>_1:mep
<br /> 11.'Ij pe of Building(,'heck.11 that a pply) Lo,X
<br /> Ior'-Pamily Dx ell In, Number or Denotes aid- '--h on Nome
<br /> nmeka O,
<br /> ❑YubndCommereard—Describe Use ❑Coo'or
<br /> GUKumhr ❑ \'illapcof
<br /> ❑Slate 0,,ned—Desert,Use �T .—li%JS..„nor_
<br /> IIL'I'cpe of Penni): IChaek nal.one bo,on line.\. Complete line B it applicable)
<br /> \ ❑ Nc,c din, lank R d,u,r<nt Onlc Cl Other nh,dlrmmion to Baistlog S"unto apbinl
<br /> Lost Prev rue,Permit Number and D ou Issued
<br /> It. El P'7Rini ❑Pearl)Re,kion t) Chanp<uPPluntber (D Permit Truns&r m Sea
<br /> lame :” imtioo U,ar, pt
<br /> IIN.'1a )e nfl`O\\"IJ>otem/Com onmv/Ilecire: (Check.11[had a t da 3-
<br /> piNonrressmixealn-e rnnnd ❑ Prsswiaa In.Ground DAt.Orde ❑ mourn>24 nootsnnabli,roll ❑ bmaad<..t In ofaainm<enil
<br /> D Holding Tank D Other Dispersal Cmnpnnertt r%,,,Ii„( ❑Pretreatment wire(e,plain)
<br /> %. 1) er,a 111 reatmenl Area Inforinalhln:
<br /> Design Plox(,ad) uesiyn Soul Application RatenaNQ) Dislersul Area Ih4uirer(sl) Dispersal Arm VroposcJ 1st) S,st<m Llevmmn
<br /> NSo . -7
<br /> \'1.T:mk Into, Cupacny a. "fowl a of Mamoru,toner
<br /> to
<br /> Gallons 0a11ous Ina'srL -
<br /> A"Ten', e.iannr Tangs
<br /> c
<br /> s<pdea Holding Tank
<br /> /4 . 0 1 //0a
<br /> PampCbvmba
<br /> 11.Ite,pomibility Stalvmen l- 1,the under._red....u,ne rupn ui bilin for i etalla lion of the Pori TSoon,in on the attached plana.
<br /> Plumber's Name(Pont) Number r Sin nature AIC'\IPItS Nu,nber I ..... sa Phone Number
<br /> /'f,_i /Gw`'-'� 6d-fFis/ 7s-SGG-v/sem
<br /> /Zrc fC /10
<br /> Plumhcr's AJdua.(Sheet,Cin.51-m.Zip Gd<)
<br /> 77G o 11—L
<br /> VIII.Coon ,/De nnnalro t G,c O,d,
<br /> Arpro,N De
<br /> ❑ Divrpro.ed rermit nee mels:am Iss//me paenc si-•„amre I
<br /> rq�
<br /> ❑OR
<br /> „ner oi,en eaaml'or nial si
<br /> IS(:and ition,of Apprn,al/Iteasonc 1'nr Di,approcat
<br /> p ECEVE 0
<br /> ,rrm b m a�mplete dar,for be q,mm and,ubmir a be Gann nm,nn ry,w male..than s u.,
<br /> BURNETTCOUNTY
<br /> sun-blox(R. 11/11) ZONING
<br />
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