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SANITARY PERMIT --- -iticn-p-±,'—,, COUNTY <br /> ; - OIL HR <br /> TRANSFER/RENEWAL UNIFORM PERMIT <br /> 44.:. (PLB 67-T) 1-P <br /> -110 t , 6767) <br /> ':ATE 7RMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN 1.D.NUMBER: i <br /> i )0 I k es— --1- •I-PS-- <br /> CITY: <br /> . VILLAGE; <br /> ,T 3 r7N,R 1g E WO c-rowN o : —1-r-aole. <br /> _4.,..... , CK NUMBER:TSUBDIVISION NAME: ' - ROAD`LAKE OR LANDMARK: <br /> Wh'Ispc,r-i'no Wind <br /> „V...T.SANITARY PERMIT HOLDER (IF CHANGED): SANITAWY PERMIT TRANSFERRED TO: <br /> •,- SIGNATURE: NAME: ' HONE NUMBER: <br /> PHONE NUMBER: ADDRESS: <br /> , • s•r.,:- .; hereby assume responsibility for installation of the private sewage system that has previously been approved for this <br /> : - ;NATURE PREVIOUS PLUMBER'S NAME(IF CHANGED): <br /> m C--E_ '5WP:(46-tf- <br /> - 7.,-(n <br /> =ss ---, PREVIOUS PLUNMER'S ADDRESS: <br /> ! <br /> ., ..-.Rc,,,, ;rer), WI_ -6-1-itr7 .1))nC I1(i . ....uce LkTr. - z-fFs53 <br /> PHONE NUMBER: MP/MPRSW NUMB R4 / PHONE NUMBER: 1 <br /> i ( /5i L7c7 -. 3JaS FAST <br /> ,...5... NG AGENT: DATE APPROVED: DISTRIBUTION: Original-County <br /> ,, ,-, b—q5” Copy-Bureau of Plumbing <br /> i ' IC,L4,7(_.., Copy-Owner <br /> 0.-7. 7 .3132 Copy-Plumber <br />