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F\ <br /> ^^Fo., Caunry UfNC7" <br /> Safetyand Buildups Division <br /> 201 W.WashingM Ave.,P.O.9O%7162 sanitary pewit Number lm be filled in by Co.) <br /> k (• �$pb_ �1 Machos.WI $3707-7162 s66 56.E <br /> Sanitary Permit Application Saida T.tiunNam6e, <br /> In arronhoce•v is SPS)S321('-).We Ad..Cod,mbm"uwnafNis ford m the appop'v¢ga--nml it <br /> quirtd prior OF m <br /> obni,my a neuy psa,orNMae,Applimm( MJ me <br /> ifafbbonsd sbnPuOalb *t Addrev(4 dnTMm <br /> erant tn ailing addmssl <br /> inc rcOcpamnmt of safcpartl Rofesovt servies. Pes»mI'vSarsmlion ya peevme rtur h tail fm semxlay <br /> inae<nInIa—. .FF-P �PriFtAll(1 m Sutio 2`19`29 iia <br /> I. r\ ),cation ln(ormalion-Plense Print\Il infonnaaion N Qr N <br /> rrallem on,� /�arK/ pawl: <br /> C/igtl /� ;e15Cide0d&- 6-4z-?Oz--4oU <br /> Property Ov 's Mailir¢A pmPmy Location ' <br /> 4 Go_39 H <br /> C', store Zip Code phaa,Nwaba section <br /> 755-7-�N�Wl �O6 zI 6 I' 7/16 T "f b/ N: R�6dNEa� <br /> II.Type of Building(check all)hal nppty) w- <br /> o12Family D•velline-Number Of bedrooms Svbdive ion Name <br /> aro k s <br /> ❑PubliGCommcrcial-DexliEe Use <br /> ❑City a <br /> ❑dale o.med-Descnbe U. GYM Norm 0vaia,or <br /> CYTmm afVfi e,e7 <br /> III.Type of PermiC (Cheekanlyoneboxooline A. Complem6neilifapPlieable) - <br /> `\' � 0 �swum f Redattn,eot syncs ❑TrvwalUlloWvlg TaNRept mnu OnW 00Ncr Modification cat E.ing S,,a.(evplain) <br /> 0. Q Pcnnit Retnxal ❑Permit]e,Onn 0 Clwnae of Mrmsbee ❑permit Tlanfa m Ne v List Preva ns Perms Number and bate Ivied <br /> Belme Expinlmn f der <br /> 1\'.l\' eo(POR'fS SvstemlCam OnenN)niar (C1lecka11thata c <br /> QNon-p1¢smizM ImGrowd Q hetnviva InGsowf ❑AutiMe ❑Mpvtl>26 in ofmivble mil 0 Mn ad<2a ht of su.tablc soil <br /> ❑Holdma Tani ❑Otter Dispersal Camparnt(explain) ❑Prereatmem Dnim(cspten) <br /> V. DiseOal/frpnlmenl Ar Idfortnation: <br /> Des,en Flo•• gpd) Design soil ApPlivsion Ratc(gpds0 Dspersal Aro Rr.(uvd(s0 Dopastl Alea PmpsaeC(0) S•pere tlevmlon <br /> Mo 6� S�18: 9yss977f <br /> VI.Tank Info Caparnym iotat aof Malwrarnda <br /> (rellms fu0nm Univ <br /> N—Teets F ivnS Teb - c c' J y y e _ <br /> J - G <br /> Seyi<mflddmg Tmk //•A+a <br /> ooun6cmanm rr(.0rxN�0 <br /> x�� <br /> YIL Res sibllity Sutement-Lthe vndasb ed+ssovm.espenaibtit>farimta6tie++r tb<POMTbahaw emunaehea plan <br /> Plu is Name IPdoO Plum MP/MPRS Nlmdcr Business Phone Number <br /> c/6 e,- %W s195�/ 7/� B66 70 <br /> Plumm's Addrca(Speat City.Slate,Zip C 1 - <br /> 27zZo Tinf ro � !W WeL�tlP 'L.-I - 4 <br /> �VaI'II-CpuvtT/Da arlmcvt Usc Onlv <br /> r APProvN ❑Disappmvcd Itmu Fa bee lsnad Ismhg Ap:vu Siglmsurc <br /> C3)tens even Reaumfm Dmol s 3ZS.00 /l-/3'/3 _ <br /> IS.Co ad ikons of Approval/Rensons for Dimppm•Oal <br /> NOV 12 2013 <br /> .vin a eomnkn nt++,dr m.+>mm m wrc.®1>.+y®wpa++ttm m+n a <br /> 1—ll lana m ZONING <br /> SBD-6393(R. IM 1) <br />