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608-831-8107 MEINHOLZ EXCAVATING 029 P02 SEP 08 '08 12:10 <br /> t [' "6-r! ;r:. i; 9 I? <br /> DG a.?G65•'7" AUG v-� ,pie.,P.O.>�tt 7162 D•re <br /> : O. t 4 sac WI'53707 7162 Sananey Pala Number(lobe fdkd to by Co.) <br /> tags-. « . 1 578 /ao <br /> �"ri�1lLl: tY"li Suite Transaction Nomber <br /> In accordance wilt I.Comm 8311(2),Wis.Ad m.Code,submission of this fora to tie ammoniac ga.amm end <br /> to obtaining a sanitary pmt NM: Minion fats for statsowad PMTS ere <br /> utot is rd to Prig Personal inhalation you provide—y be used fir secondary <br /> submitted m fie Depattoeal Commerce.Law s.15.' t I. .Stars. <br /> - in examiatce with the • Law <br /> Pared A <br /> Property owner'sNttme O7tD$. 323 . (o�3`I. <br /> Tam 4 SA,iwt (464 't Mennr ad Gustav, { • - Property I.. 32 <br /> Property Owner's Mailing Address <br /> Z'3 -f - e4 ' ? e Dr. Sic_ IoD Govt.Lot <br /> City,State Zip Code Phone Number SE 'ti, Sin ''A.Stxlioa 32 <br /> MiCto(uSOA c tit l 53"111 T 7 N: R (circle oat)E ost) <br /> cheek aH that apply) Lot s <br /> II.Type of sawn(cheek 4 Subdivides live <br /> e 1 a 1 Primly Dwell -Number of Bedroom 1`0 h 0a tNr a weavi S <br /> • <br /> ❑Pabiic/ConnreF+l-Deacnbe Use ❑City of <br /> CSM Number 0 Vitiated <br /> ❑Sate Owned-Desen"be Use QrTowt of Mu 0441 CIO" <br /> M.Type of Peruait: (Check*ay one box on time A. Complac line B if apps) <br /> IIJ 0 Repinconeot System ❑Tre*oo /Holdies Ta k Repiaoameat Oaly ❑other Modification toSastiog System(explain) <br /> List Ptrvims Permit Nutaaber mad Dente Issued <br /> ❑Pena Renewal ❑Permit Revision ❑Charge otrimebec ❑Permit Ti r to New <br /> Below Expirat1on owner <br /> IV.T I, of Povrrs - . _ . 1 - Check tai tier .., <br /> ❑Non-Pressurized in-Ground ❑Pressurized In-Gaa+d ❑At-Goalie : Masa 2:24 it.of sunk mil ❑Mond<24 ak of suitable soil <br /> ❑Peareoceent Device(explain) <br /> ❑Holdia8 Teak ❑Other Dispersal Component(er4lain) <br /> D i8 - raAwro es V Arai A Raoe(gp4s) 1�Mal Ra*mad(st) Disposal Ara Proposed(sf) System Electron <br /> Desiaa Flow Ord) <br /> 9:3e7 D Total g MsuuEactrter <br /> Gallons Capacity in s :o v <br /> VI.Tack lulu Gallows Unix a tt <br /> New Turks bawai Tasks r <br /> w t j ii .y, .6 mi u.O a <br /> GiaWlirla earn _ Z°°° l MEACE x x MI <br /> - - <br /> 1� — loon 1 <br /> - <br /> VII.R- • •- •ity Statewtat- I,the undersigned,*some responsibility for itstead:aa OM POWTS spawn on the attached plans. <br /> Business Pbote Number <br /> �/M PRS Numbo <br /> piutnber'sliantc(Ptint) t7 t65 $31.8103 <br /> .�l.ow W tv�tieh <br /> • <br /> Plumber's Address(Street,City.State,Zip Code) <br /> 416I 3 CTl--4 K \"AVON a I-te,WI 5YPf1 AIIIIIIIIMIIIIII <br /> VIII. ,..•• rawest Use On <br /> Permit Fee Date Issued <br /> Sin Disapproved S 723.- 3)a-) 108 <br /> _/ <br /> 0 owner Given Reason for Denial r /s ' <br /> DC.opal•t w_of A roval/Rasons for Disapproval <br /> AA} c �^"P Cab L ... t <br /> Cie �/^ Approval/Reasons 1 ten C3(�A. '��fr IHiS A'r'PP )''J\ ilito'1�- 0t! 11-1 , <br /> S LO� T � - <br /> Attach to csampkte plass for tie system mad soltooit to the Camay soli w papa eitibi,Alheia in It <br /> lL <br /> SBD-6398(R.01/07)Valid than 01/09 E�;E; !-1N'; <br />