HomeMy WebLinkAbout0098664-Storage TanksOSHKOSH
ON THE WATER
Job Address
CITY OF OSHKOSH No 98664
STORAGE TANK PERMIT -APPLICATION AND RECORD
855 N WESTHAVEN DR Owner AURORA MEDICAL GROUP INC Create Date 11/14/02
Contractor
Tank Type · Metal
Service · Install
Contents [] Petroleum
] Kerosene
Use/Nature
U.S. PETROLEUM & EQUIPMENT
Category 280 - INSTALL STORAGE TANKS
Fiberglass Tank Size 0 Tanks
Remove · Above Ground (~ Underground
[] Solvent [] Natural Gas
[] Liquid Petroleum [] Other
of Work
Iun~tlall 2-200 G and 1-600 G above ground tanks with!n the building.
Install 1-10,000 G underground storage tank, All store generator deisel
Valuation $85,000.00
Issued By:
Permit Fee Paid $200.00
Date 11/15/02
[] Permit Voided
In the performan.C.e of this work I agree to perform all work pursuant to rules governing the described construction.
Signa , .~ _ )'[o.....v,3. ~__L ..(~_._.~' Date
Agent/Owner
Address 558 CARTER COURT KIMBERLY WI 54136 - 0 Telephone Number
735-8237
{I
ll/14/20 J2THU 8:59 FAX
]001/001
UST/AST PERMIT CHECKLIST
Job Site Address: ....
Contractor:
Address:
AST 3 /' Install Tank~ I/" Upgrade'ran~s
US'{' /. ,t~ Remove T~&S .Upgrading Piping
Tank InFormation #I ' #2 #3 ~4.. ~
C°mposi'ion ~T~~' -
Tank Si~ Z~O~ ~'~_- ~
~ _/
Piping ~/.~ ~ .
Approximate Cost of Job: ~ _t~. ~ t~
Approximate S,an Da, e:
Pemfit lss~co Approval: Yes
No
Conditions of Approval:
Permit Approved~L ~.~//,.-~-~,- ~ Date:
Note: This is not a permit. To obtain the required permit, prescnt THIS CHECKLIST, along with a SITE PLAN ant
a CHECK made payable to the "CITY OF OSHKOSH" for the amount listed in PERMIT FEE, to the Building
Inspectors Office, Room 205 at City Hall, between the hours of 7:30-8:30 a.m. and ! 2:30- 1:30 p.m- or by
appoimment (920) 236-5045. This City Permit shall I~ obtained and on site prior to commencement &work.