HomeMy WebLinkAboutInspection Report - 03/21/1990 Wisconsin Department of Industry, INSPECTION
Labor and Human Relations
Safety Buildings Division REPORT
Bureau of Plumbing
Inspection Date
Name of Premises Address or Legal Description City /Township County
Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No.
Sanitary Permit No.
i
Journeyman Plumber /Soil Tester Licensed Person's Name(s) and License Number(s)
Owner's Name and Address
c !fir' ex." r 104 ".sR. e •s.. +..d ..f
1
0
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Page of Signature of Responsible Licensed Person (only one needed)
Signature of Plumbing Consultant/Private Sewage Consultant
Check all
Copies to: that apply.'
Original:
ssD -6192 (R.11 /85) District 0 DILHR Q Plumber r ,Owner Q County /Local Insp. 0 Other'