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•�wea- - APPLICATION <br />INDUSTRY, <br />NDUS DEPARTMENT OF SAFETY & BUILDINGS <br />ON <br />LABOR AN FON PERMISdUffrT <br />Y BOX M69 <br />HUMMA AND PERMIT SO.B (ASCOT <br />HIWAN RELATIONS (PLB 67) MADISON, of ASCOT <br />A1W More As Ne system an paper not 1115 then BN v 11 i n in size. Include a plot plan that Is cmpliined at drawn to Alb.Horizontal <br />aM vortical Hawarion reference Points must W grown. All appropriate separating dbtanar and physical Nara[M1rirtia as H,, ied in chapter <br />HAD, WiL Adm. Gd, must W showm. An inrkn page, or eaM Page must be nigher, sealed and dried by Ne desigra.11 resigned W a Mater <br />Plumbe, the date, signature and Wants number most be shown. A legible reproduction o1 Use sail tat repetl or We owner's copy must W <br />inludaa. <br />ideas <br />M 11 aff, <br />s/JW7 r <br />Pmplmr valley wi wPntw <br />YS IT rR Ici <br />iamb Na.. <br />ord .n <br />Ali <br />alta card lo. Santulli <br />DING <br />ryPI7 <br />Public' ❑ VariaMa ❑ Usher About <br />1 Or 2 Family '$late Approval Required.3 <br />BMQmrre: <br />LAHC53HRNETC6Pl5 OT5 Pom <br />NEW <br />TION Ipi <br />DTIC Tsux flPaCITV <br />LIFT PUMP TANKSSINHON CHAMBER <br />I MANUFACTURER AS <br />FFLUENT <br />EP <br />TEM <br />(Nomura, <br />M1: <br />� Flee ❑ Replace ❑ Easternmost ❑ $eappe &d ❑:;{ At <br />❑ Alterrobve lspeciNl a ❑ Sawga Tench <br />W... zogr: <br />Priran O k'nt ❑ Puam <br />rr N... r rpaN luo nn pnrardrero.rl: <br />I ii <br />I, the undersigned, hereby areume aepanaminiv rolSndmalion ar me pnratt Sung ayrbm.Mown on the attached plans. <br />n <br />Slant <br />MPIMFNNo: <br />o <br />o RVSW <br />raw� <br />}4 $ <br />b. <br />wawa, <br />/ <br />COUNTY/DEPARTMENT USE ONLY• <br />i liplag.cam: Fee �� SerdirwVPw aNerrrber: <br />f0� <br />J.rrE�/J "`tr -(-8r' ❑wurcgwep Yd L�2 /D66i <br />At A <br />ararere mum41 d nnien nuw tae: <br />Chang of ownership, Wilding use at plumber repuins a Ynitery, permit Transfer Form IB]'Tl to W Submitted to Ne ¢urlty prior os in <br />Radiation, Failure to comply will Had IM unary permit. <br />DISTRIBUTION: WTitefuunry, GnmpWerau of Plumbing, Pink Dwna. Golaomd'Number <br />oILHFSBo&iW RAi <br />