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DEPARTMENT OF AGRICULTURE, <br /> TRADE AND CONSUMER PROTECTION <br /> • 1141*amiss,/ <br /> • License, Permit or Registration <br /> The person,firm, or corporation shown below has complied with the Wisconsin statutes and is authorized to engage in the activity indicated. <br /> ACTIVITY EXPIRATION DATE I.D. NUMBER <br /> Tourist Rooming House (LTR) 30-Jun-2021 NGRH-BUDMU3 <br /> LICENSEE MAILING ADDRESS NOT TRANSFERABLE BUSINESS/ESTABLISHMENT ADDRESS <br /> SANDRA WICKMAN SAND LAKE RETREAT <br /> 4792 STATE ROAD 70 4792 STATE ROAD 70 <br /> WEBSTER WI 54893 WEBSTER WI 54893 <br /> All Permits expire on June 30th; it is the responsibility of the licensee to make sure all applicable fees are <br /> received by the department before July 1st or a late payment fee will be assessed. <br /> If you do not receive a renewal form prior to June 30th from your licensing authority, you <br /> should send in your payment for renewing your permit to the following address: <br /> WDATCP-LICENSE RENEWAL <br /> DRAWER 296 <br /> MILWAUKEE, WI 53293-0296 <br /> (608)224-4720 <br /> * Include the name of your facility and the ID number. <br /> F-fd-123 <br />