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»'rKr Coun9 U <br /> Safety and Buildings Division / <br /> 201 W.Wastdngton Ave.,P.O.Box 7162 Senior,Permit Number Ib be filled in by Co) <br /> 3P - Kl Madiman.WI 53707-7162 <br /> Sanitary Permit Application Save Tmvn°°"ambm a <br /> In aocomume.vim SPS 383 21(2),Wu,Adm.Cod,svbmiision of this fain to the apprvptee wit <br /> u mquimd primmo8ainirgdtanuery pcmit Nom:Aylimtb..I fV SWCOavad FOWLS me xsdrdnmb Pmpxt Address(ifdirf.em th+a mailing vdJrcss) <br /> �k fxpamnmt orsar oam Pmreaipml seine:. P<�b,ranmion raa prmvle max to and f>em•dmr <br /> - eemaamx.wimtlmPn. I....also>tl m sins Zy�� ! //q_� /l/ <br /> L AUJixafion Information-Plens<Print.tll tnformatiov ^)r/ �q <br /> P. Oa 'sN <br /> , Pined dOT O/V-2-T8'fS-dV foS-OxY el <br /> o e�� o/4zzoy/�c <br /> ?o,,ny Ovmr i Mellmg Address Property Leeann <br /> l ZO wit- 1:iaK� 5- <br /> Coy Sme Zip Cme Pham Nutai -7 <br /> Y., '/.. lMion <br /> C9lr/�J IN 6/Z-353'868 (ximleenx <br /> T 3P_N; R�Eo ' <br /> IL <br /> Ts pe of Buildi g(check a0 that apply) Lot: <br /> Tof Family D.vellin_^-NumMof6cdooms -L Subdivision Name <br /> Bin&a <br /> O Public/Commercul-Dmenhe Use ❑City of <br /> ❑snare Ossmd-D ibc Use CSM Nambar ❑ Vilhgevr <br /> L M..II XTmsnof��'D/C/ <br /> III.Type or Permit (Cheekonly one box online A. Complete fine D irnpplinble) 0 6 <br /> A' ❑ Nevsyuxm [ Reply«mem Sys¢in ❑TrommVlldding TaN Replsement Only ❑cher Mmi!nn no Exissin+x S)stem(explain) <br /> R. ❑ Pcnit 0.cmusl ❑Penin Rewision 10Chal ofWamber ❑Ftrmit Tmnsr mNesv Lis Ptcvbus Perms Number am Dec lsuM <br /> serine Expinnion quer <br /> �W.Type of PORTS SvstcmlConnoneo0r ice: Check a0 that apply) <br /> O <br /> ,Non-PrmsunsdlnGmmd ❑Presmitd lnLromd ❑At4mde 0Moum?2fm.nfsWtaWeal O Moum<2s in.ofmiuble soil <br /> ❑ Holdingrank OOdef Dispmxl Cmxa*ma('Plom) ❑Pwemmem Desi¢(explain) <br /> \'.Dis ersaVTreatment Area Information: .�.�.n <br /> Desoto Fim,(8pd) q.im Sol Appliesion RAt(gdsf) Dispersal Arm Rcquvd(s0 Dapassl Am Pmpmed(sf) svxcm Elevation <br /> 30 o r yz B �7 8. 9yv <br /> k'1.Tani:Info Cap"to Tocol hof Mamralmer <br /> Cnlbm Gills U. n - e _ <br /> Nc,sT Fii.i,g Tab ' U_ �_ <br /> w.rrr..t�. C J r=G <br /> Sxmxsr Fb ,Tmk �W ) Is! <br /> lma <br /> llmmliaa <br /> \'1I. Res onsibilit,Statement-I,me v.Jxr ' .rd,.s.ne xxia wania,or:mnlseoa at r4 PO Aoa-..me.n.xhxd plans <br /> Plu is Name(Prins PI MPMPRS Nmnber Business Phom Number <br /> Plumber's AWo,s(Svnt Ciry.Sree,ZryC ) - <br /> Z7ZZo T�nfWcdSf�w:s48� <br /> VllL C...tW(ye aftmcvt use Only - <br /> APPr°ved O DLsappmvxd Pamk Fa Rve lined lmrirtg Agmn Sipmure <br /> ❑Dn,,erDi.xnRtManrarDtna s. /-/-/3 'ill /z6/s525 <br /> I].Conditions oL\pprovvURevnns tar Disapproval <br /> DR ECOVE <br /> nrT it a nil <br /> .Snavh uxommk¢nbm 6r Wesn¢m am mhuam thxGmnmry mpaper.wnmtm. ti n <br /> BURNETTCOUNTY <br /> SBgh3vr(R. nn l) ZONING <br />