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Industry Services Division (J q n rrr
<br /> ,} `ir 1400 E Washington Ave smtiu,PennaNi It.1'e fined in he co)
<br /> \S,P„r I"� P.O.Box
<br /> Madison,WI 53707707
<br /> -7162
<br /> _ Hsi
<br /> Sanitary Permit Application
<br /> Inas I' 1h\IS 3Yd. IQI „i:. \1 l .h1i I I t th a p I 6 enrol Inti
<br /> @rcq dl ' t hn- g a uninars ennit. Note Ap,h I i It JNAVIS 1 tinedt ,eIiAlln hl dhnl2m thannaling nddi
<br /> nmol fSry II I _:' ,IS nn'I-If t ,I,,,dl y be ue]fin,cnd:n S
<br /> onLrnr wth thr Pir Law 15,040 H.I.SGa¢ (i/1GN
<br /> I, A\) lirdial Willi—lWane Prim Nl lnrornmunn Lrn dR Z&ft
<br /> P hill Owner's Mane Panel
<br /> 70W .�eP'clman OT-OFOo-/(r%4•SOS-OeS-
<br /> 013 bOp
<br /> PmRnyOwne7<Mining Addi ) < P ir�ny Ijon
<br /> 3 e( A 1(/0 V uu, J St l' W Gnt t.I n, S
<br /> City,Si IIPdnn
<br /> e IIxte Nder /.. Senion /4
<br /> ?l/er G(o y s--G37A Idrele ane
<br /> II.Type of Building(i all flnl apl)ly7 LI,s I 4bA• �: R_/(e_F.r ('
<br /> 9Ior21'n111i1111ssOhng—NumMn+Or Bulrmm'lc_1 `( SUNIII sion NXIle
<br /> IIIneA ll
<br /> ❑Pnhlic Cnnunemial—DesdM Use
<br /> 0 cit .,r
<br /> r
<br /> ❑sol.owned—IkxcriM Uva, (sal Ni ❑ \'ilbec of
<br /> Y P lls ® le,nof OI Ad:
<br /> III. I of rernlil: (Che�eyk Inns one liar nn line A. CmnBlete line B if nppncnhBq
<br /> '\' El Ness system �RePhe.menl Syrmm ❑1lealmenvllnlJing Tdnkl4plva.n¢m Only ❑ aper NlodiGallionm C:,isting syemm le,phin)
<br /> It. ❑ I'a nh Itamwal /�Pennh Re%111 t ID Change of Piumher ElI'emiit'Lansei m Nes. Lia Pi N'mnlwt anJ Dme Isxed
<br /> B.Yun Danintian Owner
<br /> I V.'It pe of POO•I'S Ss swan/Component/Ibeice: IChi all that aj),II
<br /> 0 Nei....I Li-0mund ❑ Pressuri"Irr mi ❑ A,(j Je C >hvnl>'_J in.of uhlble mil ❑ .11 I Z4 in.of animb1v a it
<br /> 011.1 ng Tnnk ❑Other I),,W lCor,enent(e, ipl ❑Prelremmcnt Dee."(e,pbin)
<br /> V.Dis ersal/frratmeat Area Inform iflon:
<br /> Ucsign I°law tend) Ilcsign sad A\pplirnion ItutIXspchO )"ter,nl Amu Baptised 1,0 Oi,n,AArtie Pmpwed Iz0 >".IIII I"2B
<br /> Seo �7 S�dS %37 9r.a� 9Y. b
<br /> V 1. lank In ro Calweirvin 'foul nor Nlnnubaumt _
<br /> Galli aauana llnu - —
<br /> • Iank, P.I fay IanF — —
<br /> Is
<br /> „yne a.Hemel,f..a
<br /> t,u,insch,tti
<br /> \'II. Bcrpo ilrilBr Statement- I,the undenignetl.ussleiv rwponvibilitr sur imenlalinn arthe PIIrO6.hawn nn t I's.11.1i It..',
<br /> I'Ipmher'e Nante(I'.in0 Plumher's Siknmurt \IIVSII'BS 6umMr Itnsimwe PN,-N.ri
<br /> /?,.le /c,e. s � �j+�� J•d-S�'/ 7/s-r9GG—,Y/S7
<br /> I'IntnBer's Addi(Sveel.City.Stec,Zip Cci
<br /> 7'7GGzlei
<br /> � GlieSs {r w1 SYfBg
<br /> VIII.C.... De Inst meat 'se 2
<br /> Appmrry ❑ Dmvvtn.zd �) ) $t
<br /> I'I Pee rote(caned slitting ltins Agent signat
<br /> CIOwner liiven Reu nlin Denial 5 5b.0,)JU !y�'^
<br /> Is.cnndniInr.ar,ytprn.nmeenenns for Di:anvrn.Id 1
<br /> �r�+^i SGA l?/ PGrihs� P(¢n, SAS re/�OOfMar,{' 6 /ar.K. D ECEIVE
<br /> nn
<br /> Amen to r..Aepry p rom ror It,s.o.m.t 1.111.me Cee , Dory on l'+Pr wor h„u..np• I n. �. -
<br /> BURNETTCOUNTY
<br /> slau.or)d eau l b ZONING
<br />
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