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ichart•'1 cow <br /> Safety and Buildings Division E <br /> (}r• D }.:`: 201 W Washington Ave-,P.O. Box 1162 <br /> ;\$ t r1 91 Sanitary Yermtl Numhcr lloM tillN in q'Co.) Ji <br /> P I Madison,WI 53707-7162 <br /> { y�s3l 4-- <br /> Sanitary Permit Application Shm, Ira" mm.N.kr (jl <br /> In acenNmme with SPS 383 21(2),Wis.Adm_CW e,submission of n m this roathe appropnma gnvemmened unit <br /> is mluirN poor to ohWiningaswimn'pfnnil. Nnlc:Appl icelion tionorslale-ou'rcr1 vO ascmhmitlN to Pmjaat Addmss(if dillerent thw mailing:ddttssl <br /> the 0.gmanem of Salm wd Profcssiaul Seniez. Yenarml inf mmhan you provide may beasN for sawdary <br /> n ccsndwce whh the l'rivv 'lau.s. IS.btfl m Stott �9 <br /> I u A lication Information-Please Print,\II Information _ <br /> RA, <br /> Pruriency C vwr's NamParcel <br /> Name a <br /> r•'\G C Cts. 07-93 3 —14fs —oSool-of I(K,i <br /> Pro ,q O,nof's mdingnddm.. Pmtcny l.owlion <br /> mw 1 QGJ „ aiJa Go,tlut�j <br /> City,Sue lip Cade PMrc Numlrc <br /> IL'1'>rp,e ouf It ddoipf Rt h <br /> T 3�r section <br /> 17 yHnreJ, ew <br /> (check a all tatapp ) . q <br /> Uor2 Funny Duelling-NumhcrofHulraoms <br /> / le' <br /> - <br /> Subdivision Nmoc <br /> Black 8 <br /> DPuhlic/CommmIial-Ih.n1rcIJ c <br /> ❑City of <br /> D Smm(TcnN-D uriM(Ise CSM Number ❑ Village of <br /> Vd4R3a) <br /> 111.'1'y pe of Permit: (Check only fine box on line A. Complete line B ifapplicahle) <br /> \' DLIV_S'.. D Repheement Syncn DTreatmem/Holding'rand.Replmencon OnlY D(fibcr MM,fiend.to Rsion,Svnem(esplain) <br /> H. D Permit Rercual D Permll Rmision D Change err Pho her D Permit Tmraf to NeuList Proxious Permit Number atd Ilan,lssuN <br /> lief re lspimtiw (Toner <br /> I\'.'1\'Imt of POW"I S Sstem/Com ment/11m,ice: Check all this apply) <br /> blur-Pncssurircd In-(bound D I'mom iN In-Ground D AI-Cmde D Mound>2d m.ofsmedile soil D Mound 1 24innCmilahle su'l <br /> D Iloldimlank D Oder DisMrml Comparamt(explain) D Pmvemnenl Pvrce(cnphou <br /> V.DkitersoVI rimurnmt Area lnhhrmatifin: <br /> Dcn,PTow(gpd) Ihsnor Soil Applicmon Rate(SpdsD DkgvsaI At.Rerommd(10 1h,Paml Aria Pro,""loll System ln'W'o 1 <br /> Oso G �IZ y� .D <br /> V1.'I onk Info Calsaca—m 'I irml 9 o Momfourer <br /> Callow Cellon, units <br /> Nex'I mks ft iom6 Trots u " <br /> a`U uU 1 <br /> Seco,ar Hohim,Tod, 0`130 <br /> De .,(lmmM VV J� <br /> VII.Responsi hility Statement- I,the nndenignm,ensu - ilil for intathonnoflhe PONTS box n no the utarhed plan. <br /> Plu 's Name(Prim Vlumhcr' ignex 1' YNS Numhr {usiness PhoneNYmbCr <br /> nl �vRckJ S38o3 -715-gIII19.1- <br /> Plumber's Addmss(Sumer,Gty. mzipcode) <br /> yz i - <br /> Non S P�� ✓ ��, ��� <br /> NJ 11.Counts/De admen, Ilse Ooh <br /> fkmtitPre oo Plc Issued ssui m <br /> ISigmlme <br /> n(mmaN ❑DiaappravN s 3r PiY�/j <br /> o LT,mm Given Reb,<m fur IMnial <br /> IN.Conditions ol'ApprovaVReasnns for Disapproval <br /> P Emd[ nn <br /> rik <br /> Anuh b mmplen Pham fonhe"o—mE sahmp b our Com,only on p,r nes Ir.•do.8 to x 11 err <br /> t AUb 9, Z013 <br /> SI3O-43Y%IK. III III <br /> BURNETT COUNTY <br /> ZONING <br />