HomeMy WebLinkAbout0068087-Stoarge Tank ,..� '� CITY OF OSHKOSH No oosaos�
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OSH OSH STORAGE TANK PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 845 HIGH AVE Owner UW OSHKOSH Create Date 1/13/99
Contractor FOX VALLEY PETROLEUM SERVICES I Category 280-INSTALL STORAGE TANKS
Tank Type ��ofe�a�---- - ----`�Fi er lass-- - Tank Size Tanks
Service ns a - - -�� emo�e - �I �A ove roun n ergroun - -
Contents e ro eum o ven a ura as �
erosene - �Ciqui e ro eum �' Of��---
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Use/Nature �C�lecfion o p an revision ees. - -- - - -- -- -- ------
of Work
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Valuation $0.0 Permit Fee Paid $22.00
Issued By: Date 1/13/99
ermit oi e
In the perFormance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature Date
AgenUOwner
Address 1700 LAMERS DR LITTLE CHUT WI 54140 _0 Telephone Number 414-788-4470
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. ' UST/AST PERMIT CHECKLIST
Job Site Address: � �c��ZFj.J �-/ �t/��
Contractor: � �C ///�GL �=�' ��/-7�L1�Lc-w-. Sf";'��i� ��i
Address: / "7�n� ,�/��,ZS" /��
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Phone Number: �f2o — ���-- yy�� Fa�c Number:
AST Install Tanks Upgrade Tanks
UST Remove Tanks Upgrading Piping
Tank Information #1 #2 #3 #4 #5
Composition
Tank Size
Contents
Piping
Approximate Cost of Job:
Approximate Start Date:
Permit Issuance Approval: Yes No
Conditions of ApprovaL•
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� Permit Approved by: Date:
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Tank System Fee - Plans Review Fee �..? ,4' PERMIT FEE: �"—�
Note: This is not a permit. To obtain the required permit, present THIS CHECKLIST, along with a SITE PLAN and
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 12:30-1:30 p.m. or by
appointment (920) 236-5045. This City Permit shall be obtained and on site prior to commencement of work.