Laserfiche WebLink
_ 001(etG el,ZQ-2021 <br /> '1 I cow• <br /> i ` j Safely and Buildings Division s is E_ <br /> - 201 W.Washington Ave.,P.O.Box 7162 S:siiy Penni:Nuabc:l4i he filled in-by Ca) <br /> '• Id Mattison,WI 53707-71+52 <br /> Sanitary Permit Application stale Tmmet;on Number <br /> Inaeordemce wilt SPs 35321(2),Wis.A&n.Ca:-,a ssien ofdols form to the appropriate eeveremtmW anis <br /> is required prior to obnioiag a sanitary permit Nate:ApplicSriun ferns for teato.o u x POW TS are sehmine..to jec:hath (if different tem ail nit]g ada-ant <br /> the Deparm:e:of Safety:ad Professional Service.Persons information gun provide may he used for so.rozday] <br /> .u.. St de Low. .Stas. i - ZIT-7 <br /> L A•.licetion Information-Please Print All Informationj 1-Li-t i rte... C l P-4-ir'_ <br /> Property Owners Naris Parcel F <br /> rAtl\' 12.14.P.A1,1 Fa,04", o ..1-•trGYtl•C <br /> Pre-petty Owner's Melling Adl ass Property Lerztien <br /> • <br /> .(1t2. ii:LLIt> i °. ckr..Lel_ <br /> CCI... + Trp Code Phot Nmber G, 1`;•c_ !:.Senn .l <br /> IVI Al>tg,c e4.. s•-..1i l 53714 I V (etrdo one) <br /> LotF T , }:; R n F.er4V <br /> II.Type of Balding(cheek all that apply — <br /> Ci'l or"1 Family Poeibae-Numl�zr of Be ...4 <br /> -- Gl S=bdi ia7w_Name <br /> • <br /> Bixi= k3.Ir t,ai ii-, <:--i Oil.E. <br /> ❑Puhlic'Conmen ial-Dosed be the_ ❑City or <br /> CSA1 Nornher ❑Village of �.�.� <br /> ❑Stile Owned-lksrribe Use <br /> El Town of VC-E'-,D iA <br /> - <br /> i <br /> M.Type of Permit: (Cheek only one hex on line A. Complete line B if applicable) <br /> R �y L Icew System 0 Reply--•r^of SySreei 1 0 Treattrti^.i;ilolui`g Tank RcpL=emc•t Ori}' 0 O_t:a\4o;fSaatim-'to E:iadrg System(rxpliin) <br /> B. ❑Permit kemewal ❑fermi:Reisior. - 10Choagcef?3rmber LPermitTnrsfertoNem <br /> Lu!Prei^ion:Permit itimitxr seer!Do-laud <br /> Before.fzp:retion Owner <br /> q IV.Type of POWCS SystetnICempanentlievice: (Check all that apply) <br /> ❑Non-Presourird la-Ground Li Presevi cd lc-Ground LI At-Grana gMeund>14 i of suitable snit 0 Mound o 24 in_of ssitsbli soil <br /> ❑fisbling Tin:: 0 Other Disptro i Caapearst(explain)_ _ 0?rcaesOo*nt tilm se lcxplainj •_ <br /> V.DispersalhTrortment Area Information: <br /> Deeipl Flow(pd) Dcsip .•liartioa RueCapdsi) Aispersol Area Rn uired(S() i Dispersalos <br /> Arca Proprd(SOI System Elays4on <br /> i-r..:.'• 15(x:: i 11'�(..? 1115:: ) •157.47 <br /> ti 1. Atprrefictiner <br /> VI.Tank tufo 4111111FCGalllsns Tetal 1 <br /> -� CtsiSoas L'aftc - i - } <br /> Nor Tarts Bilging hats fi <br /> t1 I! _ SSUU <br /> s_.,u:Huldiog r::x I 12.- [12%, 1 l K-GA ix= I X t <br /> D.yiny ChsSe I `ru., 1 — , 457... I 1 I. -iN 't I • i 1 <br /> VB.Responsibility Statement-1,the nodes-igmed,assume rerpmilbiity for imstatts'doa of the POWYS'boom or the stmelied plans <br /> ?timber's Name(?rias) Plumber's Sie sure — VIM'RS Number I Business?bone Nuasber <br /> i <br /> treioe.w LV. bc,l•l'4'� '41•-•'...--- - <br /> --- .---_-1-i '.).� .:-tl-., i(A,.=ip >hli-;.,2.110 <br /> Plumber's Addrma(Street,City,Sam.TP Code) <br /> L.:r.t :�y.CL-I 1,.... 4VriL.r iGf.:".P-•-ii 5•'...'":::,:l ..........- .........r.,:7-"'"'"' ---.-....... <br /> VIII.County/Department Use Only —eM.Ii 4.c. ( -zJ <br /> Posit Fee Dau.Issued , Wing Algot Sponse <br /> 'Appro+..- 0 Disapproved <br /> S <br /> ❑Owner Gives Reason for Aerial t t ! /'2.L'' r 1 i' 4- .`t r�A A J_' <br /> IX.Conditions ofApproti ansforDisapproval tom <br /> I • <br /> Protect&Maintain:gi Mound/❑ At-Grade site and 15 t downslope in its natural <br /> condition. No compaction,excavation,disturbance, or vehicular ra rc allowed. -- <br /> Alt,:,°t5 rompl:i: ENSURE PROPER TANK SERVICE ACCESSIBILITY:l'..'1''?a' <br /> Vertical Distance Tank Bottom(s)to Service Pad:415..ft <br /> SOD-6_4S(.1111I) Horizontal Distance Tank(s)to Service Pad: .I5C ft <br /> Specific servicing mechanics must be provid l'Fverlical is>15 feeVY. <br /> horizontal is>150 feet.` <br />