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conalt, a <br /> rya Safety and Buildings Division <br /> l C ` <br /> 201 W.Washington Ave.,P.O.Box 71 B2 Saeimyp itw (mtmmiaimbyC .) <br /> l, Madit".Wl 53707 7162 <br /> l=Ps` <br /> $ �0 SPrnI- -I o <br /> Sanitary Permit Application s zH y <br /> maconnnee rh SP538321M.W-MAdm ®it N <br /> i,,, dprior ma1mini8 a smftmY lcmR N Applica no fame fm 4acoavrd POWlS mmbmnatm Projmi Ad&ms(ddilaam[d®a' -a6dtm) <br /> the Depeomm nrSaf ty and l fmimei Srnim. Pmoml iobrmaim you Pavidr®Y be used far smaodmy <br /> purwses is mmtdewe with the Privwy Law,s-IdAdl m Ston. <br /> 1. Application Information-Please taut All Information <br /> Nopvty owner's Nene Pare)L <br /> NATG m N v3y Z- 37Z2- <br /> Pmpwy0umWsMadmgAddtm ROPmtY lnrmmi -p3-000 - )309 <br /> City.Swm <br /> "PCode ]•hove Nvmbay, IYU y,, Smyianz z <br /> S x/837 time <br /> G� I 1-V ' T .Z N R /8 F,aP <br /> B.Type of Buildings(check all that nPPlY) 1.wg <br /> k1 m2 Family Dwelling-Nimbm ofl3em msm, Subdivision Name <br /> BmrYi <br /> ❑IiddirlCammoad-Dmmae 1)a: 0 LSn,ut <br /> ❑stare arced-Dmrnhe 11s Nam>R or T12/ -- I-AIC✓= <br /> OL Type of permit (Check only one box on line A. Complete One B if applicable) <br /> A' ❑Nrn Syw® System ❑Trmmmt/No1 - Tmk Rcplaomsa 0Wy ❑Olhm MadiacaimmLtisuor Syst®(eplm):-' <br /> B. ❑Pe®t Rmesal 11 Noun Revision ❑chmaeofs'hmhm ❑Ranh Tramfmm Nmv Iia Pteaaav PmttitfmintlQ and Ume lmvtl <br /> Betur Fphaim Outlet <br /> IV.Type of POV sS m/Com0neat1PuA e: iCbeek all tbata <br /> ❑Nero-Rrsmiail hvCnamd ❑Pemviad ml'is000d ❑M-Gimde ❑Mom i>24 m.Mamffik soil *Mamd<24' orsmt de <br /> 701toltiftTmt ❑ITha DiapctaelConspmmt caP�^> ❑PmncmnmslXrim(cRlem) <br /> V.D'. try moment Area Information: <br /> Daipt ow C--A Dm8niaAp union Radgpdrg D¢tmml Arte Rcanbd(st) Dispmsal�Proposed(SO SySIMIa vation <br /> 5 J1 <br /> VI.TmR Info Cidltm Gilmta Univ Mmufamaa a <br /> Nee Tats fimmg Tm <br /> a�a,�"ET� lYlcJ !serf, <br /> noya5(amW <br /> VII-RespovsibilM Smtunumt-L the aadrrsivaed,aamme reapavdbaity far ivsbRatiav arthe POWTS shavM m We mmrhed plans. <br /> Plumhw's Name(Flim) PImMm's Siemtme 1Obrr Oasinm Plmoe Nimber <br /> .SUFI z `IZ -715= �SSZ`lb <br /> Plumhm's)ul t (Sft {City,Stere.Zip Calc) <br /> P o. s s Iz�ssc s yW g <br /> VID.Count-/De artment Use 0.11 <br /> DPemit Fee. <br /> tome ismed IssuiA�tSitoaoar <br /> S <br /> �Appmved ❑ iSNwmYed 37r7o �'�/y-/y ltC �Rya�aeoer, <br /> ❑Onw onrn..roc Doul <br /> IX.Conditions of Appros ]/Reasons for DisapprovalD �3`��( � <br /> /roarS-r 1a. rAt'r ZaN/A)G �Cj- l Fat �GOw/NF i�vfPELttaJ HGA.NI fii76,e i v. <br /> LA-rCR9GS LRtD, Q�E'FaYLE CAaHNG. <br /> AUG - 82014 <br /> (.S�- Afhd mrompkhpmm fartaeswtm atl mhait to ttr Csm9 M-mAsamstmtm.am rf m>or <br /> BURNETT COUNTY <br /> ZONING <br /> SBD-6398(R 11/111 - . <br />