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_r <br />E <br />BURNETT COUNTY <br />ZONING <br />PYlfvc/I("1Y'A_l <br />1400 E Wasirboon Ave <br />!sP.O. <br />Box 7162 <br />M71d6ov6 W1 53M-7162 <br />Sana�y/Permit N'7u�mbba lie fitted m by Cn.j <br />Sanitary Permit Application <br />Steft/Tjr� ion `'r <br />in aceada nce with SPS 38321(2), Wis Adm. Cade, dose of this fam to the.aplxopnoft unit <br />+ 7 , <br />Project Address (ifdifferem than owlmg address) <br />is mpiW p w to obomwe a satay permit Nate: Apphoation fomes for state -a R POWTS at submitted to <br />the Department of Safety and Pn&==md Survtoes. Pcowaat aftmaeiam You psavidc may be used for sawidary <br />purposes in acconleo a with the s_ IS i m Stats <br />/ <br />! l �O dq O I1 � <br />L Bart Infertaatisa - Pkase F rbat AN Lfsraiti dion <br />Property Owner's Name <br />—1aD �N� 'V <br />Parcd # <br />M/--- p`75�0—iv�b <br />Property dwmaw s Ma l(i�g.{g/. Address <br />Properly location <br />vO r BD) f V" <br />60vt Wt <br />— yS 'K. Section <br />City, Sime <br />zip Code <br />Phone Number <br />cird <br />T N' �+"`-' E otn <br />1L Type of Bailding (ebak aB brat apply) <br />Lot # <br />Subdivision) iame <br />art Family DweH*-Nmmbaof$odmoms <br />NO-rF <br />5 t4a -'W 01-: bi V bFKV <br />O Pttbtic/eaari - t7,acaibe use A, l <br />O City of 14 1<9 <br />© State Owned- Describe use <br />O Viii V of <br />CSM Nam bw <br />TO mofft bb XvTaC <br />Ill. Type of Perm (Cbaxk ady one bs: on fame A. Cosaapiebe l ee B iiamble) <br />A. <br />O New System <br />System <br />❑ Ti NHo4,iingT=* Rept Only <br />O Other Mo&fica oo to EMAtog systema (WOM) <br />B. <br />O Permit Rene d <br />O Prmit Revision <br />Chensc oPmber <br />O P,.itTransettoNew <br />List Pevwm Pemt Mmber ad Date ssued <br />>� <br />, <br />ly7ov ��-5— <br />Iv. TM <br />of Pours S Cbscic aB that <br />IQ Gromid 0 Ptessas=W kWwo xl ❑ AWkaft [1M=Wi24moFsuftWsoH O Mand <24 w of lesoil <br />O HaidnTamk O tllher DVersd Case pwM (cxplain) [IftetrestmentDowice, <br />V. ObsenwWreab c Area Isfistawfta- <br />Fkw ��{� <br />D*=W Am Proposed ( <br />system <br />6.7 <br />f Ze 8(d <br />4L5-020 <br />VL Tied[ Ie% <br />capacity in TOW <br />Canoes Cw1ons <br /># of <br />unft <br />Abanubctwer <br />.I <br />NmTsft tav�Tasfa <br />I <br />w <br />A <br />a <br />w o m a. Ch tis, <br />KJ <br />Septic or iioldigT=& <br />res <br />12-6e e Z5U <br />I!r <br />YII. Ragwoulnifty <br />fit- I, flee iar of the POWTS shaver or the att abed pbas <br />PiumbesrS Nmre (Ptmt) <br />'ss- --T <br />Musba <br />Bay Phase Number <br />(304 --�k <br />Y�35' <br />�71,5-- 94,t, <br />q30& 13LA44 WON< -90AL)l � <br />1=3 <br />Permit Fee <br />:3'i `-� <br />Date Inued <br />Agent <br />O Owner C*vem Room fiw Dewd <br />-&- 17 <br />Ix. C o[Apprai Ift flsr Qbaappreval <br />S;a���or y `ca�rw �`ewt /iPcordrd '�r3 Belro&ws = '9 aAea - <br />,l's aee Atd1"��t <br />Go fl e�'scws <br />Amek taeaaptae #Ms it aie syees moa a�Skts die ce�elj r4 era wt� � t� des s irz: i <br />j <br />a1r��a <br />sBD-6M4Lww <br />OCT 3 0 1017 <br />BURNETT COUNTY <br />ZONING <br />