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r„noly <br /> /`f�.•c` V'„ Industry Services Division �Ls r rl6 <br /> !yr�s��t � 1400 E Washington Ave sanna7 Norio Nuner(to 1,fnd iin by Co_) <br /> y P.O.Box 7162 <br /> Madison,WI 53707-7162 <br /> ?•aw`. Sanitary Permit Application ""`I r°""°J°n oral ` <br /> In mlan with Sot Jlil'_q'L Wie.Alin.Cmc,noba orIt fano mile innmmimesov caul nnil <br /> -urq IPo I lo- .ryl iNi AOWTSano,oloi Pr]aiAll ::(f4imaa lbmi nn'1'ignAJeLss) <br /> the Dy rtnm of SnfUy Il oleo-onal5 lens 'I- i ire yol pail mnY le isulk Eemnlary <br /> . .uealnncewlm Ile Pnvaev Lav,c I>_off Dojo.Srais <br /> 1ili AceLcation lnforimmon—Please Print All mrormorion <br /> rmis'nJ on,od.nnnla o ,J6. <br /> in <br /> /von}S Ser ov 3 <br /> Jo Qnn 00 ,n C o 0/ 3oCtl <br /> Pmisco,JWIIIfI Wiling AIdlc, Pere"Locaioa <br /> .J <br /> I I lrOZ�?0 iI /7p tical.Lal <br /> City,Snm I Zl'i Plane Norlort y / S-uen /S <br /> fcirelconcl <br /> 11vOSrm „ Hf on)A) SS068 T NO N: R�Eo� <br /> IL'I'ype of Building(check all that apple) I or g <br /> I ort Fairly 1),elling–NoaberonleaivonaSubdryrostl Naae <br /> Bien kft <br /> ❑PobkLCmmneleiol–Deem,Use <br /> ❑atynr <br /> ❑Simeowald–Desnbcilel, CSM Numinr ❑ VIII.11ef <br /> 1/� 3 ® fa ,nr_ _ <br /> 111.Type of Pa nuie (Check <br /> say one box on line A. Complete line D if appheable) – -a – d <br /> A. ❑ No.Snicnr xNe"nanmm tiynem ❑'Icloolii,,lda,Tnnk Replauincl Only ❑ Other Modlfiaaion lr Existing Syniem(c,blie) <br /> It. ❑ Pmolltenaxvl ❑ Poole,Ruvleioa ❑Clnngi 11....lbcr ❑Penin Tmns@noNew 1.isi Previwra Penoalelon Pon I Dote l ssacd <br /> Ilcfine E.xPlerioo Ower <br /> I\'.Tc m or PO\\TS SvstcmiCia o ent/Decice: (Check all that,, i Iv) <br /> ❑ SomIne,al ui l.(pleand ❑ Ihv.m red b.amian ❑ At-Grid, ❑ K1 1124 no carsnimbi,soil ❑Well I 24In.efmimbn,alt <br /> XUolJlnslank ❑Olio Disposal Component apinin) ❑Pretmain"ni Oeviov(cxVlain) <br /> V.Dispersal/reeler ra Area Information: <br /> Design l'lo�dul Virgo Sail ApPlication l<aml6Pds0 Ilispenul mm�licgnircA fsD Disf 7snl Alen l�mn�*sad(sO Spwa[ilcrelion <br /> NT TankInfo Cnpachya total uor a91ar-loon <br /> Gina... G..11— Units <br /> re, lank, tikiing luny _ .,^v <br /> - � L <br /> S,pu—rllomiogrw: <br /> uorlia cnrnmT <br /> N'll.Roiponsibilitr Sheraton- Line infer ¢d,n cspnnsibilitr Por installation none POWIS.sun n llc:alntl¢d plans, <br /> Plninlx.'s Name(I'nnq saIi ul r''z VIgnawn MI'/M1II'Its Numl¢v liensess Pham Nmnber <br /> /c / /a ddSOs/ �s- 66f- y/SJ <br /> Plninbcr s AJJmu($outs CiIY=9imc Zfp Coda] <br /> 111.ConntdDcpa Iran t floe Onk <br /> Annioval ❑ DLcaPpn eA <br /> Pc it Ew Dam haat I–zing emSimmwrc <br /> idp <br /> ❑OwnerGiven l<eason lbr Denial �� L� <br /> I\.Conditions of ApprocallReasons for Disapproenl <br /> D EC�EM <br /> eiwanmromMi.i.pian.mane:. niam auninii rn rM1eea piety nnnpor nal lest manxle. um.�n . fr 9019 <br /> to <br /> SRD-639S(R0313) BURNETT COUNTY <br /> ZONING <br />