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. 02/18/98 16:16 NO. P03 <br /> PERCOLATION TESTS ' . <br /> I, the undersigned, hereby certify that The Percolation Tests reported on this form were made by me or under laiy, <br /> supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative ' <br /> Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. <br /> NAME:NAME:aha it. jiaklist TITLE *stet Plumber <br /> (Type or Print) <br /> REGISTRATION NO. . or MASTER PLUMBER LICENSE No. WA <br /> ADDRESS /915 W. Main. ate, Sii P &itia, tii*s, 5. 5 <br /> r <br /> DATE __MT 271! 1 .$IGNATUR i • /.� <br /> Ill MASTER PLUM= R AKIN AP-LI •TION MP A <br /> ! / / ' Nkijk <br /> Signature: . Ph e. . License Number: MP RSW <br /> w sec- S. <br /> For: " i _. A Provide sketch below of system <br /> o f Iger) ftecW• direct/ nand oercentpt Rlnoel <br /> I I i . • <br /> ' 1 ''11 <br /> ■ • ' it' ot, I 1 I •, 1 . <br /> — -......._. ' ., .. - -- -ia .�rt+-' 'IT • AP VA[S7TA1 - F VdD r — +_ <br /> _ _— XEA.RS- <br /> �, (p FROM T. DATE OF APPROVAL <br /> - -- ---#p /(' -- .. .. . . -.�'- ,_. ._ — -- - <br /> 1 IA P All PM • ' ? ' <br /> IRIS P ROVAL;SH <br /> — _._ .. —. .. --—,— --- — ---..__ .v ■ :. , : 1 •PROVAL Of.TN_E„_ _ <br /> 1 _ �Y -- •Od of HEALTH. Qir, , , <br /> I , I — IR 9 rove ...___ , . , <br /> , r 1 , 1 <br /> I I lv4. a i'� I <br /> i <br /> . <br /> . ; <br /> . TA It �.L,, - - _ .._.. <br /> .1 .. _his .Val is Da�ed_q_.Stgtepiu .i11 01/� ._,_...... —, - --- <br /> I I I i6ode Fea igemenfs and .oes not p : <r•. 1 <br /> �_._ theist Idtion from c' . rillege, •W re <br /> , I ! <br /> I l roit <br /> I <br /> 1 <br /> t• <br /> __ _4 , _ _ _____ tir, . . ____ _.._r 1_4 . , ; , .4 1 <br /> ---r —iiir fr.`,741i - 1 4,- <br /> like'gm <br /> Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. <br /> I :41, Do not write in space below--FOR DEPARTMENT USE ONLY <br /> ; i <br /> - -, Weil Application 6 -.)- 72- Fee Paid " �,' 4-°•; <br /> / Permit Issued/Rejected (date) 6 - ) - 7 2- Permit Number 4266- 3'9 o/J� fo <br /> Sanitarian(name) _ (97,214;;;S:. _Soil Type �•-� -1 p104 J r9� <br /> 12 SeCr <br />