|
c� Con ny-z
<br /> Industry Services Division
<br /> ; \ r� 1400 E Washington Ave San,u Penn,Nonl,en ho le title(]In by Cu.l
<br /> P.O.Box 7162 &7r
<br /> Sr ' Madison,Wl 53707-7162
<br /> V
<br /> Sanitary Pennll Application '°' I ron—nonNo ''
<br /> Inarc l. ':n SPS 333 2 1(2).a'is Adin,C 1 h Ion, 1 o -ip 1 b nn tai on.,
<br /> n¢I IPin, ' obt E nno—,nil M1a Apples onl sfsse ao.n d1061Surc Xnb tittalu Yrdeet AIdmz[td1'lenm lk mall ngud(]reisl
<br /> the Ife eir oenl of Safelr mut Prol2ssinml Sen us. I'owml intimnmin i y ....vide may 1,.,I for"coodnn
<br /> MI� u ..Llan"with:.,privar La w.a. IS f1111)Onl,1:.111. S /H 1 {✓{ton/w �� /`�
<br /> Application Information-Please Prim,\II Information
<br /> Vo,n„ Owner's Nalre Pne,el p
<br /> e� eta,1 Y/ /S J/p°J oeo
<br /> web /'mac at•OeO
<br /> 11mleny Oona Main,Add.. Pygmy Locminn
<br /> /,169 Aee G ynl
<br /> Chy.Smr zip Cmle .lone Nnmben ee5w ,: Seninn 3J
<br /> (circle one)
<br /> IL Type of Rnildinl;Irhrck all:hal apply) Inlp f Vii/ R. R /S [nyv
<br /> ,6II...21z nl1,Dedlina-Number ofunl,nom, 3 SuNfivolnn Nan,
<br /> RIeek n
<br /> ❑I•anbe Cnmme.iel-Desmilu:Use ❑ City of
<br /> 11Sen,0,o,d-Iksoibe Ilse CS%lNalnbe valayeof
<br /> p no, vi/ e1—oef
<br /> Ill.'fypeufl•ermiD (Checkonk one nos online A. Connplen•lineitifapl)li`'alsl`'1 03a' oZ3 -0 -70D
<br /> A' ❑ New Syaent X Rrylnee,nen:Syetnn ❑"1neunnvNDoldmafnnkurnlarrmunonly El (life hlodidutinn.I!xleb'ng Sy"'In(eaplin)
<br /> II. ❑ rennet Renvmal L] Noon Re. ,.n ❑Cnan,e,n fluorine, ❑I'n ni:Tr o,t r to New Lia Panum,penny Nuhn,,ami Dale Issued
<br /> Itelure F.xplrutinn Owl e
<br /> IV.'I'vpe of POU'I'ti Scvleml(:omponenllDm9e¢ fji all llat Rpplr)
<br /> A Nee pee.cnmuun.amnn 1 ❑ Pnxnmed ln.r.u:l I ❑Lei 1,11e ❑ blonnd_>2J in of untablemii ❑ Mound<V in afsunable doll
<br /> ❑ Iloldiny TanA ❑Omer Dispvaalfomtnnem le.phiN ❑Preneebnenl lk,ee oc,ba
<br /> V.Dis erval/I'reaunenl,\rea l nfornmtion:
<br /> Design I—lglxh N,,n Snit A,he,len RatefpgA.O De,enu1 Area Rcyulnd(zp DulenaL\rea Protuned 1st) Syaem Rlovllon
<br /> 45-0 1 gee y// 9F. 7 9c- 7
<br /> VI.'Iank Info Culunry in "I olnl put Alunulimmml � '
<br /> Gallons Gzllom Units
<br /> ,u Idnkx alai plonk. - - -
<br /> iV
<br /> Scpe or n.ld1 nP pnk /
<br /> /O°O W/GJe✓ JC
<br /> 1v I Ih
<br /> V11.Reeponsibilin'Slammenl- 1,no,uodersi V ed,.—unm resnonsibirn for in.:all:uimi none POR-a.n....on nye..rhea pions.
<br /> I•IumM'a Fame 11•rof I'lu.hen's""onun AIY:]IPRS Numhrliu.inea:-hone Numle.
<br /> A° i
<br /> Plynlner's Address Nt"'.CITY.SIm4 Z,'CG le)
<br /> d 774a //` 3.f !T/c5sf v art S"Y AS-jr
<br /> VII Cmmn/Dea rt em liar Ontr
<br /> d,pn...rt ❑ Ili "(]oven Penni:Fre Dote lesned p lenaine Ahem S,oamre
<br /> ❑ owner Given R—on II..Detod 1 {Q• q '{
<br /> IS.Conditions of A,prn.alBrasons for Disapproval
<br /> nn.111.10 .Pine Plan.lnrdt. _ :e m amlmM1ml uu.1%,1 _ nnn,n Voter nm leulM1mXe-.Il in
<br /> BURNETT COUNTY
<br /> suD-girls tRR3 u 1 ZONING
<br />
|