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RECEIVED <br /> • SEP 2 8 10b <br /> Public Me V■M! Camay <br /> ��u Envi <br /> ���� s� lft ' lan <br /> i� 201 W MWasl Ian Ave,7-7762 715E $adtury PvmB,Yum6v(tow 6Ad by co <br /> 13 .20k5-002_9' o <br /> �y Sanitary. Permit Application G"MTimaaeltaaNumber <br /> Is ocuanimsee yid SPS 38331(31 Wis.Adm.Cade,submission's!'this faun m UsappuPaee goeaaasam(mk <br /> • a regeisd par as obtoinog a wdoy permk. m Application F o r m s 0°Oed POWISmemiladdefIo Projcn Addicts(faurnem daa oeU•.ig w ) <br /> dm Dep rimed c(Slop and Pmksfo oI Srsrits.Petard idmmllanyou provide may be toed Ibr y: r <br /> Purposes w=ado=whh the Primes lave.a WWI Am1Sims. _.._. <br /> 'I.AmBiotionlararmHoa-Please Print ADInformaSm 3rl UAlicti /g ."A"! <br /> . .. <br /> Property Owes Noa* `Tared I <br /> I'7/ (xien2 k/'1iv -. / <br /> PmPan.oem%hlm7mg Address n cejt7` t2I/�724° <br /> &1-(C l K uo (}41( f„�'yr r^ CO cd s jt2. 1 <br /> �eu'e Lt-ii- 5 g v <br /> cask as any- <br /> Lot it T G7 N; R EorW <br /> II.Type orBalldiag(aback aB that apply) 1 Nome - <br /> El Iar3FamilyDndling-Nmaberoenthrons '� Z . sdudivlMw <br /> tiladcf . <br /> ❑Puh(>FlLamtwciai-t3esclheUse i1 ..�t:llyar • <br /> O store Owned-Dewar irse /'(:9M Number i 'I C�(,I � • ,, <br /> // i 137frL aieu er �eEkt . <br /> ill.Typ of Permit:[Cheek only one box oaif ieA.Comidate eit ffat>alim � <br /> A. NerSysrw l Q Repineaemt System ❑TreotsmmAfokSeg Tank lteplsesmm Only Ill Other Isinxfrsmton to Edging Syslae(=plate} <br /> ft. ❑Pandt Rama( I❑Pawl(Ravishes Q amazeotPkanker 0 PemskTmasferta Non LIM Pry Paduil and Dale tssaai <br /> Strom fipimtko Omar _ ..... <br /> IV.Type of POWIS SystenticompmentiDecie=(CI Ii(isat apply) <br /> fl Nas•Pmesoized ba•Gmuad ❑Prateur ed ln•Cuamd �KAs•Glade 0 Moomd>24 in.orsuitohteasS ❑Mama e2,4 io.ofssdmhk wit <br /> El Holding Tank OOdsr Dispersal Gam men((euplaln) . ❑?macaimmDerire(e=plein) <br /> Y.Dispersalrrea^n^ntArea toformailarc <br /> Desks Flow(Igol) Design Sae An ilmdam Rn d) Dlspcssal Arm Reguhad(sq Divan]Arm Proposed(s0 Sysmom Usr/r <br /> (nC`O 8fo ICS lam .._ Is . <br /> VI_Tunic Info C lo Mo®Eamer FW� � <br /> 3ra.Toots Existrag Trots g I u - -e. <br /> c.u m m c o o. <br /> awn Chamber --KP Teak ) I` ( mss+ I <br /> viLResponsibility Statement-t,theaadcrslgned,acme responsibility far imtall: mofibarowrSsbamu-oil she attached wham <br /> rhaber's Neme(NM) Pkm sSrgmnse I MPIMP((S Mardis Bad=PkooeNnadas• <br /> Plmalar's AddractSeW,Cdy.Smle.Zip Cede) <br /> /j g3 C'l I L'LlL f' 6,_,r- <br /> ` - 5--3ff 4 <br /> VOL County/Department Ilse Only _ <br /> CI Approved ❑Dlso(gwved I5 Permit D�oteIsssud bead&Aral <br /> El Owner Gina Raman for Dada) 2 A /-1 5 <br /> Lt.Conditions or Approval/Reasons for Disapproval <br /> Mesh se ampler.pbes far the maw awl stand(to sea G®lyand as pater act l rteao I sac ti Mega Iasbs ,. <br /> 5804398(R.1 Ill I) <br /> • <br />