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r . <br /> - Cotm <br /> safety and Bufldlrlgs ITWIdiDit Dane <br /> .s ,a I 201 W.Wast tcmANa.P.Q.Box7162 Sm yPegauti ia(bbelowinbyco.) <br /> Masan.WI 53707-7162 <br /> ' 13 -26 Ls=ooa tl <br /> Sanitary Permit Application SsmTrmoeticoNmobc <br /> la aeeadsne with SPS 31.121 W,Win Mm.Code.submission of ids saga to 1leeppmprrme sormrmeedtvr¢ <br /> s required odor babsioioga'amitary penult.Note Apprteoianroetakr.sta ovmedrOWISere saboAled to -Papers Ando:nig Wagon On mailing°Mess) <br /> the Department of Safety met rmrcmwio Sixvies.Prim'inTormetion you-provide mar be used Par secoadiry <br /> sumo=io=oda=with oe Primp taw..IS 4(IXm),Dsa. Andor Lane <br /> L AspUatiioa bitumen=-Please Print AN aaaniell' <br /> Property Owner's time Patel I <br /> Kyle&Kaleena Stephan 0911-192-0535-0 <br /> Pommy Owra'sM Mthos Property Loation <br /> 2131 Effingham Way Apt 109 <br /> Govt.La <br /> (ly,s Dp Code Plum • NE % NW y,,seek= 19 <br /> Sun Prairie,WI 53590 T 9 R 11(+ eam)EarW <br /> 11.Type Bulldog(cheek all that apply) lot l <br /> ®I or Family Dwell)-Number ofBedromne 4 15 'Sub:Hvni*t <br /> Block y • Norway Road Estates <br /> ❑PtddtaCammaeml-Describe the ❑Ca7 or . <br /> CSIANarabar <br /> ❑Doe Owned--DeteribeUse ❑waver <br /> MToon of Bristol <br /> III.Type of Perish(Cheekooly one bar out line A.Compkte>iao.BIfapplicable) <br /> A. ®New System •❑RcpLerma*Syeme ❑Trestmentfifoking Teak Repbconeo Only ❑Other Mod liiation to Ming System(e n) <br /> B. El Permit Remand ❑Petmd Rerun ❑fl.0"ku aer ❑Pettit.1...0..104.., Lisl Previous Ferrol Madam sad Dele rssmd <br /> Beta Expiration Owner <br /> IV.Type of POWTS (CitadeaR Otat apply) <br /> ❑Non-Pressurized In{tamd El Pd Ia.Gnaanl CI Al-Glade Iti Mooed>?Ain.ofsuiableswl D Monad<14lo.atsadfejiesea <br /> ❑Holding Took Oath mlGoomnaat(espial') ❑PWreamed Dena(explial <br /> V.DispersaVfrntmestArea laformatIoa: <br /> Deter Flaw(grid) DesistaSoil Application Rate(Sd) Duman)Aiwa Required Kt DLpand Area Aopnsedtdl System Me <br /> 600 1.0 600 608 99.8'8.100.6' <br /> V7.'Dusk Info in Gallons ISe A/antmmer - u <br /> Gems rtes Tons Teaks $ .� '�- <br /> Sep6L-'14 airs Tad' 819/467 - 1286 1 Meade x <br /> Dosing amber 650 650 1 Meade x <br /> VIL Respwalbiiky Sla eme41 1.111e sirridrlIped,.smam imp few hstanntkas Maw ro rs slams s on the attached plaits. <br /> Pinnies Name MPtvrt) Phether's Simulate MMMPRS Number Business Phone Number <br /> A/1dru.,, w. Meal,(..,, -4....4._t Sao 1 6S 4 r-P3i-41o3 <br /> Plumber's Address(steed.C y,Stale,Zip Code) <br /> 6 813 cffh /c." Wa.....t.J(•.•_ 1..);,. s—?.f5-7 <br /> �VsI//I''L Cosn.ij ,• Uses. ' / / <br /> .4pmved 0Damenoved .S_••.lie DPW 1=414, "r y yAlW <br /> ❑.o.nrlinlra�for Daml (2 _ I 1 I = - <br /> DI.Ceadiliam of ApprovaWReosuas for Disapproval ' ? <br /> /�6 <���la ample*Ouster the spbuiaYsit Is Vac alb'ma •.1 ley Om 114e Movies <br /> SBD-6398(R.I I/11) <br />