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UA# WU# AA <br />• • <br />•» <br />f/»n iirn <br />hi^CA W99 9nh <br />r*T.T <br />PIcnsr^Typc or Print Nojtly <br />rriTikif <br />»l IWI HI W %w9 v««If • • <br />for Industrial Activity (MN Q610000) <br />MInnMOla Pollution Control Agtney <br />REM Divtolon, Industrial Stonn Watar Parmit Program <br />820 Lafayotta Road North. St Paul, MN 85156-4194 <br />Minntsota <br />Pollution <br />Control <br />Agonqr <br />■1 <br />R^ftr 10 ifu appItcoiloH burtructioM uyoii complete thitfirm. Fkast type or print neatfy. <br />Site or Facility IntorrTi.ilicn <br />1. Municipally Owned or Operated FadlMaa M oMars skip to port A. 2. <br />For anmlcipaUy owned or opented tnduiirial ftcHitics, designate smgle or multiple site pcimit coverage. <br />0 Single site pannit - □ Multiple aits pennit If multiple aitea, number of aitaebed application fonni:______ <br />P«r mmklm^h eiwiW *r cp^attPhiAistri^MMUll. nth «tthtelr awMtnMce smwpu, fat muti anaih • tomplttt cppllemlon, prtptrfyJUInl ant, fitt <br />Mdk tOt. In tmktthtO pann wuh •mmO rtomilMliy «r «n ^ffittellf rqmmwtM mar r(pi tadi ippnetikn^rm. <br />2. SHa or Facility Ueeatien <br />NsmiofStttor FtelHty ^ <br />lfoo-7 ^►iP<LC. l^ 1 Vl £■bfi..• <br />She Strw Aaarew (Atttal toeaHm Imktvtjka %far • rural tilt, (f aefin S mdieott laeotirm m s rood mtA gS#f«tyCt !9 nearttl mu.^^MpQHty. Dc not wrt m AQ. dw./ <br />5T3K Hevu <br />CtcyorTowfiihlpI <br />(a).^rfeofr <br />Scots Zip Cods Couaty <br />Siift CtMilACl Lssi Msffil Firm Ntms <br />• <br />* Titls <br />MN <br />Ste Cwact MalUDa Aidnai <br />y<x 411 9-700 <br />< <br />AL iU^t^T IT-^ ^0 L ‘SlMl <br />Seals ZipCodfi <br />J9kfikm9 (Iti^hkk §rm EeMatl Additit <br />PMT adrfpiiir 0&OMtJ ( <br />MN <br />:iiy ScKS ZiD Code <br />Pdblic Land Survey (legal deacription) information for tbs iHa. Refer to property tax itaiementa, Em county auditor's office, or <br />county plat maps to ob^n this infomvUioa. <br />Tba site or fcciUty U locamd in the DNE DNW QSE QSW quarter of the D n E D n W D se QSW quarter of <br />in /.atr *7 jtownship. Township #________Range P .section <br />3. Owner Informatlen <br />Is die sita'i owner Infotmation difCereat from the site infbnnatioo prov'ded above? If yea, provide owner QYas QNe <br />OwntrNAms I <br />OwnerCo«lMiU«Hiim WruNsnw . , Tills At , Td^lWMnot^, <br />5^ Cr /vlotiiJ:> /W/J sXig</ <br />Owfitf Adtfmt 4 Bp Cast <br />•swnaj-r;hrOUrnkMftlbmnWmo *mKP4f^kaskB Ihfs <br />11 <br />;! <br />!: <br />II