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Safety and Buildings Divisive : <br /> 201 W.Washington Ave.,T.O.Box 7162 Comfy Dane <br /> De a a tm nOCSin (608 266-3151 7162 fined Commerce <br /> Sanitary Permit Application ID. ,.. <br /> Iiiiijiiiiiii <br /> 0 Y-OG/ <br /> Is accord with Cam 13.21,Wis.Adm.Cab,permed ioibtnriaa yin Pw;ae <br /> may be�d�se ondary�p'oses Pr'ivacy14w,s13. Condition (Approval 375 <br /> L Application Information-Please Print AN Information � �cad °ro moll* )address <br /> Own's� Buckeye Road <br /> Grace Evangelical Church Lot,/ BloctN <br /> fit' + 008-0710-132-9700-1 <br /> P.O.Box 8780 <br /> City,State Code SE <br /> Madison,WI 53708 w NW section 13 <br /> -- <br /> iI.The of Building(cheek all that apply) r 7 wade de one) <br /> 01 art Family Dwelling-Number of Berkman <br /> R.--__B or w <br /> �tlibGdcesasereiel-Demobs Use <br /> Church Subdivides Name 0111 Number <br /> O Sale thraed-Davao Use <br /> Metes&Bounds Parcel <br /> ID.Type of Persil: (Check ody ace has N Nee A. CS,shslebs Ise B i<app ) ��°fBfoom. Grove <br /> 11 19 New System 0 Repiacenee(System 0 Tank ltd O Iy 0 Other/Acidification <br /> ❑Permit Remold (3 p!� 0 b � <br /> Be!fae Expiration <br /> Plumber of ( b New List Previous Permit Number sd Dose haled <br /> IV. 4 oPOWS: • Meek all that i <br /> ES Nos-Pressmimd fa-0m d 0 Mood>24 in of seimbie soil ❑)mod<24 in.at <br /> C.esiacted Wethrd 0 Promoised le�hvemd 0 H ldisg Took 0 Past Max 0 Amobio Trersesms Move Pas Seed raw 0 <br /> : ,, , - Med'*FlJi 0 - •. Chamber 0 t '.,Lim 0 atarel-lass 0 g°�Op g3i•d,�6er a <br /> Other -.,, <br /> Design Now(gi«1) <br /> D Soil Apgar**Rate(tpeht) D ma. Acs Ratsi rd(id) Diploid Area Proposed(st) token Elevation 1826 0 4 <br /> 4565 4572 Fhor ill <br /> New VI.Task late Crpe�ci■ty in " of� 94.0', 94.5'IN=�_' .r Ueeie/ g (8666 <br /> 111111iiltilTiallillifigillealtali Meade <br /> ■.. ,., v. _. rMOM <br /> VII.Res ��� <br /> • , -'s Name(Pris$dttaasemt-I,tie rpyes 'fie woe - ter�eistes of lie TOMS down me ti.Nbel Number <br /> •'r tret'`i W 11h(�2 I a (GC�� �a0a•Phase Number <br /> ---,_ a T.t. .. .. v..Saga, j. e.'.!. g� <br /> mai 13 w Peewit Fee(srJsda Deb haaed <br /> (Shiva Roans for Denied <br /> IX.Ceaditiems of Apprevel/Raseas for Dips I �� <br /> 11! --.1,-N.:-:t::1•;! t ii.: ,. . rte. /' <br /> liw.. la.11 c.a:.....,.. . <br /> ... <br /> rip;!:l to Or ,: C...:-.903 C' .......:,. <br /> Mead! l o. _, . L.. <br /> •e pimp(le the eNf) the • on paper rat ten re.m IlLa s III timbal is eta <br /> SBD-6398(R.01/03) <br />