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<br /> j �? Industry Services Division Burnett
<br /> :Tr OS `*"�• 1400 E Washington Ave Sartain Penn Numner no he lined in m Co)
<br /> \ P j Fi P.O. Box 7162
<br /> .S• Sv:l Madison,WI 53707-7162 S669ol
<br /> Sanitary Permit Application Stat,I ranmction NumberZ
<br /> Inaecordlnce aih SPS 383242),W., Adis Cdc.suhmi.....of his bun mlheappromiase-,mmem,ti and
<br /> is ey d!prior to alujinne _-p \are Application forras for dartivornisect POWfS are submitted to pried AM,,,,af,hu nenvhan mvlu,address)
<br /> Iit,n pan r of eates and Proassional s Per,anal'm i ss ort porde may ae used tar weerdar, 1480 Kessler Rd.
<br /> u
<br /> enrdara„hhe rono'Loo,s.IS Olt(Nm).St.,. `
<br /> IApplication Information-Please Print All Information
<br /> Pa,ui uwn,r s Name Parcel n
<br /> Geoffrey Hicks 07-028-2-40-14-02-4-04-000-011100
<br /> Nation Owmr i nailing Addms Pro'. Lueumn
<br /> 1649 Geneva Ave. N Go.r.Lot
<br /> arc,Store Llp Lode Phone Namhrr SE , SE /, s«tion 2
<br /> Oakdale MN 55128 T 40 �_ R_14 Macllnnw
<br /> IT.1'ppe of Building(cheek all that aPPl>I le,t a
<br /> RIm2I'amil>Dwelling-NumhrofD r,x, s3 S.dislsmn Nam.
<br /> Mark
<br /> D PuhhCComme....I-fl,:cane(J.,
<br /> ❑Cit.or
<br /> D side oared-IksaiM use C561 Sumner ❑Village of
<br /> R Ta„not Scott
<br /> III.T2pe of Permit: (Chale nal.tine ho,an lined. Complela line It ifapplicable)
<br /> \ Nms Smpm ❑ Repluc,menl S.acm DTnatmentilledid,Porn.lt,lrcem,ar bob' ❑O ha 11-11,S,ztem(...lair)
<br /> If. D Parma Rae„ab D Panit Ramon D Change of Plumhr D Permit Transfer Nem List Previom Tamil Nonuser and Date Issud
<br /> I{prole rA'nlrat'Ian D.par
<br /> I\'.l'. enf PO\\'lS Ssaem/Cam ocol/Device: Che[k all that i Iv
<br /> R son-I'nnwne,d In.emam D 1'ressunecd In-Ground D At-Grade D.tdound a 24 Innfsaitahle soil D M t nd 124.n or saitanbe sal
<br /> D Holding Tank 01 Our Di,,—1 C.m,.,.,(eaplainl ❑Pramztrnem Desna(e,paim
<br /> 1'.Bis a saVfrealment Area Information:
<br /> Resign Flo,(,N) Design Soil A,unauon Irra,,tri Disp:rml Are Re,uircd(so Dispersal Arca Proposed 611 Ssstem l lesion,
<br /> 450 .7 643 650 93.0
<br /> \'I.Tani.Into Cetera, n )oral aof aannfarturer
<br /> (ianunscanam umv
<br /> Svw luta. Ii,i trap rix4a _ tl a _
<br /> JV V'
<br /> xpmm uddong lank 1689 1000 1 Weser X
<br /> IA"mg rTrvntce
<br /> \'It.Re.ponsibilis Statement- 1,the undeniRned,vsome repro-unllo far imtallatb of PO\\Thown on the aevehN plans.
<br /> I'lumbcr's Name(Pr I) Plumbvr'sS• ru c MI'/MI'RS NumRr 0uziness l'hnne NumMu
<br /> Rick Brown 231251 419-0739
<br /> partner i Address(Suet.Orr.Sat,zip Code)
<br /> N4606 Greenfield Rd. Spooner WI 54801
<br /> F IDL Co.on/De art mens l 1,e(Inn'
<br /> ❑A,,seri ❑ DIIDpWO\-rJ Prm
<br /> eit fm Dhated ated loam.'Agent Sigruture
<br /> S
<br /> ❑Unna Giron Reason Dur Dniial
<br /> IS.Candid...of ApprovakReamm for Disapproml 9bLr.UV1 SU
<br /> APR 21 2014
<br /> ' 111.en1.roplo,pro-m.me,.v.m and s.nmalwh.em. r. int. nraP•,nm ort Itio. 11, if inro F C-17VOIJNIr
<br /> ZONING
<br /> SDD-6398(80313)
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