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G 4. . <br /> PERCOLATION TESTS . ' . ,► <br /> I, the undersigned, hereby certify that The Percolation Tests reported on this form were made by me or undef y '• <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 4C 1, f c IV 4V7'-X.d 8 1 t TITLE C i )1 YRe_e-47' <br /> (Type or Print) <br /> REGISTRATION NO. or MASTER PLUMBER LICENSE No./!l/� <br /> ifirk4I{>r-"` <br /> ADDRESS <br /> TP.) ,3 6r? 2 c- 4- p C7: c 9, /l 's 4-3 (a dler <br /> DATE 3 /, 7 2- SIGNATURE <br /> MASTER:PLUMBER AKING • •-LIGATION MP ,,,, <br /> Signature: — ,a.rbli�._ I( ense Number: MP RSW 4, 1 <br /> For: Provide sketch below of system <br /> (employer) (Include Al and percent of slope) <br /> ' y <br /> n_ N006C <br /> - � .§ . . . - I. ,o <br /> ilk 0 <br /> 0/i <br /> o <br /> t. <br /> Ity b . <br /> N t •• The application cannot be considered for filing until all of the above questions are answered and the fee paid. <br /> 7-/ Do not write in space below—FOR DEPARTMENT USE ONLY <br /> e". bide of Application 7_‘ L Fee Paid $ /0 / <br /> `7 4-7 / �30 �o6�y <br /> Permit Issued/Rejected (date) Permit Number <br /> Sanitarian (name) Soil Type 5q-2 <br /> 1 po...,.Gpca n-.,.7 et.-4.4. gr ri+^4-10 , <br /> r___ 4 4 •• wt 1-n0Un Dn■ienrl 11-0'1.7n <br />