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Safety and Buildings Division Cowny <br /> m 201 W.Washington Ave.,P.O.Box 7162 <br /> `�SCOns�n Mad�4 WI 53707-7162 m:7��111'Ml�ffiedmC <br /> Department Of Commerce (609)2663151 <br /> Sanitary Permit Application Slate Pbm I.D.Number <br /> In amend wilds Comm 8331,Win.Adm.Osmla,Penrod i do mmins you po'ide <br /> nary be used for sccuday p spam Privacy lAw,sl5.04(lxm) <br /> Project Addtm(ifdiBerant than rail' addmm) <br /> I. ApplintiomIaformatian-PhasePlint AdInformation 27(.34, S'tINp(J�`I,�^ Imo'/tl <br /> Pmopaty r>wv's Name > 1 jOAD <br /> Parsed 8 1-t# Block f <br /> L©1�1 f A SM It1� n3&-W25-617Ob Lot e <br /> Propmty Owul Mailin✓/g1`A\-dtrke(v{��. 1 Prrgarty l oatim <br /> -nI 1= 4AIA1LEIV DP, <br /> Citl soft <br /> m <br /> Zip Cade Phe Number vy — Section Z5 <br /> Sr PAUL. MN 55)IB bI2-�55` �OBZ <br /> 1I.Type of Building(cheek aR thet apply) T qd it R <br /> Aim Family Dwelling-Numb,ofBad,,m 2 Sm�dwi.=Nmm �jCSMNumber <br /> ❑Poli Wmannamid-Dal use RAl nF SHRON 6Lr-&; <br /> ❑Sue Owned-Desenbel%, ❑City❑VilIW4 .;mshipof UNIO <br /> III-Type of Permit* (Cheek amly one hoz an Bae A. Complete line B if applicable) <br /> A. ❑New System Ew. <br /> strm ❑Tlolding Tank Replacement Only ❑Oder Modi6mticn to Fxistin8 System <br /> B- ❑%mitRamwal ❑Charge of ❑Pa nit TWml to New Iad Pmvv Peron Number and Dau Lasucd <br /> peonPlumber Owner <br /> IV.T ofPOWTS amthata <br /> Nen-Ptamaimd b�Cnomd ❑MmmdI>2A m ofauitsbk mil ❑Maud<2q-m.ofauilabk soil ❑Atm ❑Smite Pass Sand F7trr ❑ <br /> I Wedand ❑Feted loCruud ❑Hoklmg Tank ❑Peat Flier ❑Aerobic Tam mvm Unit ❑Reaimdeting Sand Filter ❑ <br /> RmomWmB SyrNmtic Meda Fater E114-hiMaw-ber OpripUnc ❑Gurvel-Im PiPe ❑odw(cepkm) <br /> es _. <br /> V.Dia reatmant Area Imbration: <br /> 3 (gad) Design sail Appli cation Ralc(gpdst) Di4pasd Atm Regdted(� Diapvael Arm Proposed(ail System Blevetim <br /> VL Tank Info �� �i35 SQ�T 953U <br /> Capacity in Total Number Menufacumer Prefab Site Stmt Film Plastic <br /> MWGalena Capron ofUnila Concrete Comhmmaed Glen <br /> Ttmb Ttda <br /> StgtieolbldiagTask <br /> Amalie Tmmwamtthit <br /> LwW Lineal <br /> VII.Rmpamaib'Sty Statememt-4 the undersigned,ammme respsambm7aty for ingtalukn#gwthe POW1S shown an the attached plans <br /> :Pbmnb:ee,Addma <br /> r's N�(Prim) Plumber's Bmmnm Phone Number <br /> TE 213Z�Z 71s -755- 29�1 <br /> (stmt.City.stma yip ) <br /> 1'O, &k 515 EK led/ 59009 <br /> Ven rbuntum Only <br /> Appoved ❑Dbgaoved P ;Fm(mdudm GmommdwaterDate lensed Si (No stamps) <br /> 11 <br /> IX Candid=. Approrm 1 Given fo Disapproval Reason for Deniala�K07/D -,Z l- '0.. <br /> JI, l <br /> SEP 1 9 2W5 <br /> OUNT �I <br /> Amcacaaytterr phm(a tieCemq mb')ser amaramam PPar trmtrs atm <br /> ZONING <br /> SBD-6398(R. 01/03) <br />