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PERCOLATION TESTS <br /> I, the undersigned, hereby certify that The Percolation Tests reported on this form were made by me or under my'. , ' <br /> supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative <br /> Code, and that the rd'ata recorded and location of test holes are correct to the best of my knowledge and belief. <br /> f/ <br /> NAME C 4 7 /A( S ' (V TITLE ' <br /> (Type or Print) <br /> REGISTRATION NO. or MASTER PLUMBER LICENSE No. 1 8 Z <br /> ADDRESS!? 5 1 O o - 1-1 "TM t■I LA,' l S '> 3 `) 8 1 <br /> DATE / 41 //' / 7 `._ SIGNATUR C <br /> MASTER PLUMBER MAKING APPLICATION MP 2 7 -r <br /> Signature;/. 4a_c.., License Number: MP RSW <br /> For: JhPrrrovide sketch below of system <br /> (employer) (Inbhhde direction and percent of slope) <br /> ; <br /> y1 - <br /> ' i <br /> • <br /> al OW e 1 <br /> I- <br /> _— <br /> I ■ I — Jogs f-- . <br /> 1 IA-MK <br /> 1 <br /> Q <br /> f <br /> s I , <br /> 1 <br /> • , <br /> ' ' t I <br /> ...,A,..„..41144 okt_11 ' .5- .I <br /> � 1 / , Ti <br /> 0, <br /> �. I <br /> i <br /> ote: The application cannot be considered for filing until all of the above questions are answered and the fee paid. <br /> Do not write in space below—FOR DEPARTMENT USE ONLY <br /> Date of Application /74-72— Fee Paid $ ,,2 U �7 / <br /> Permit Issued/Rejected (date) ' / 7 Permit Number/ 1-/ /17 <br /> Sanitarian (name) © �S`/Soil Type e. <br /> e....., 1 1_1A_7n nneun Rcuicarl 11_98-7n <br />