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Wisconsin Department of Industry, INSPECTION <br /> Labor and Human Relations <br /> Safety&Buildings Division REPORT <br /> Bureau of Building Water Systems <br /> inspection Data <br /> Name of Premises Address or Legal Description Cityntownship Count, <br /> 157PLYs6e) fI1'✓ %kADE <br /> Master Plumber Name and Address Master PI umber R ran Name and Address Plan I.D.No. <br /> Sanitary Permit No. <br /> Journeyman PlumbeOSoil Tester Licensed Person's Name(s)and License Number(s) <br /> Owner's Name and Address <br /> -VT - - - - <br /> I <br /> . ..—..-. _ .__.. <br /> �11 IT <br /> 1 RL <br /> e. <br /> a3• sa'e ---93 -awW'.- -- - oilty - - — -- - <br /> Plv - - <br /> • <br /> I <br /> I l , <br /> Page—of_ Signature of Respanslble Licensed Person(only one needed) <br /> /Check all Signature of Plumbing ConsultanHPrivale Sewage Consultant <br /> Original: Copiesto: \that applr <br /> �oeF•a,m ..,a„ nict.ict nnu HP nPI—1 nn,.,eo, nn..��.,n.n nrnl mom., nntbo. <br />