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�N Nr a Cord,
<br /> /�f J•, Safety and Buildings Division
<br /> .Jr, 201 W Washington Ave., P.0 Box 7162 sanimr.nano NmnMr(nbe liltedoby C")
<br /> Sp'y t'I Madison,WI 53707-7162
<br /> :tom' 558932
<br /> Sime 4anrunion Numbar
<br /> Sanitary Permit Application JJ
<br /> Lr nrdmr „irh SPS 3932112).Akri1.Adm_Codesubm ..ions lbnn In the uppropriae so, vnul unit +G VIcw
<br /> apJaJ prinr In eMuiningu vm'dup'NMIlt Nom:Applieudnnronnsfursmte-own,Wl'Ol19Sar submlRedm PrnJect•\JJresc(ifJil&real tlmn muiling uddresx]
<br /> the nl,unmint nfsmxy and Prat sinml slydes. rermnal inlbm,nrion,-on provide mary or rrvm 1„r.e.ond—
<br /> e�wmanll,111n me Prbaly 1„e.,. a uu l(nn.Stals- 1951 CL j2� 4
<br /> ItrrA'�er�minn Inrnrnrrrrnlr-rlmr,Irdrrt.ul ernrrnlaann
<br /> I•ropany D„na',Name ((-_. Px,d v o>-o t vy
<br /> I'mlmlty owner's Atoning Address Pot”, Location (/-N-f IU:023'•//u-d,
<br /> asr RA vein T Go, Lot i
<br /> City.Stare %ip CtJc Phone Number S. : Seidn, za
<br /> �aJ�Pn S /NN ,$.5033 61.), 9.C77 /903 1 Cf0 N'. R�Porb
<br /> IL'I}pr of dz'riin,(ehreh o 11 that apple) Loth
<br /> �. I or'_10vidy Unelline—Nomlrer of Bedrornns Sol..Isum Nome
<br /> nloak a
<br /> ❑Piblicic annmlal—Ilesnbe U'a ❑coy of
<br /> ❑state toned-Deseibe live CSld Nalnber 541 ❑ VI Iaae of
<br /> W1. 2Erato of .5"'77'P� a .Z54
<br /> II I.'I jpe of permit: (Cheek only line box nn line A. (rmplete line 11 if applicable)
<br /> �N,,,e Synem ❑ Replaeenrem Sy,rem ❑'ricrlmenVlbadiay rant:Replaannem Only ❑Other Moddlcanion to B,itdng Sit slam(esplain)
<br /> II. ❑ Ycrmh Renewal ❑ Parma Revision ❑Cbanuc of l'lumhr ❑I'ennh'I'rvns&r ro Nov List Previonc Parma Numher and Date Ismed
<br /> Ilei ne L,pimtinn owner
<br /> 1\'.'fvI'd of l'0\\"fS S,\IrmlGunponerrt/Ueliee: (l;hPek a l l(It.l a Plly
<br /> XNnnRresmrimd In-0rormd ❑ Presari.ed In Groural ❑ At(;,,da ❑Afonnd 1'_J ln.of unable mit ❑ Mound<2a ln.of suil'ubla snit
<br /> ❑ Iloldinl'I'ank C1 rather Dixl'e'r,al Conrpment(eaplinl ❑I'mnnunent lkval(eeplailp
<br /> moat/I'reru cat Area I,if...nation
<br /> :
<br /> Design Pb,Il&NI Ilaign Sni l Appheurinn Rorelgpdsll ❑Ispeasal An`a Rrynnedfn1) Di,persdl Arca l'mrum•dlst) Sv,temIv%ariun
<br /> 300 . -<- 1 60a 660 `1R-AO
<br /> l'1.'I'nnk Info Capacny In -anal knf Nlnnufsaurer
<br /> Gahan talion Units _ ?
<br /> se.iam.
<br /> Loo.,Tank, E5 Z
<br /> Servitor noldi.,I'.ok QOC S"O4 X
<br /> Uniny CK...
<br /> Y11. Itcc Pon,ibirrty solenient- I,rbe w.11,ieuM,..,nate re.pnn.ibirrs hn in,mlh ion of ter I.0\\'"IS.hm.n on the auae eed Platy.
<br /> Plumber's Name(P-1) I'lumbrr:I Senarure >fPd\IPIB NumMr Bu,,is,Phane Nmnber
<br /> /�o cJJ-f&s/ lir-,flGF- v/s7
<br /> PI Gr�AJJmvs jSk C'Ip'.State Z"Cod"
<br /> 7760 W-- r 3s G�-c s/r[ G✓j S48s3
<br /> Counry/De rannr Int Ilse rinb
<br /> Appm,ed ❑ Di,, ed rennJgtele� Uma IsvmJ Issuing, _e gnZwa
<br /> ❑Dor erGia nl(.v nRalko.d '3/11`-' 'v' /D A�r[.. l3
<br /> LC.Cnnditinm nf.\pprosal/Itr:lit.a lirr Ili.nppnnal
<br /> 111-1"uen.n...c"loonv to no,o.lnn mm. logit In 1111 ea %voll un raper not l,.l rhun i n:.l l nen..in.i.e
<br /> SIID-639N(R. 1In 11
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