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� CITY OF OSHKOSH No oosa2�o
OSH OSH STORAGE TANK PERMIT -APPLICATION AND REC�ORD
ON THE WATER
Job Address 663 W 3RD AVE Owner STATE OF WISCONSIN Create Date 5/27/98
Contractor SGS INC Category 281 -REMOVE STORAGE TANKS
Tank Type e a i er ass Tank Size 3000 Tanks 1
Service ns a emove ove roun n ergroun
Contents e ro eum o ven a ura as
erosene —� iqui e ro eum er
Use/Nature emove - g s orage an
of Work
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Valuation $6,300.00 Permit Fee Paid $100.00
Issued By:
Date 6/3/98
ermi oi e
In the pertormance of thi I agree to perfo, work pursuant to rules governing the described construction.
Sign� �— Dat
AgenUOwner
� �,�- ��
Address W4490 POPE RD 12-7 MERRILL WI 54452 _0 Telephone Number 715-539-2803
10-11-1995 11 _ 13AM FROM OSHKOSH FIRE DEPT. 4142365295 p 2
UST/AST Y�RMIT GHECKLIST
Job Site Add�ess: � 7j r� /7"v� �
Contractor: �t 2. C� ��1 V�r b r� +M �.11 I'�. �j -rj L��
�ddress: �'Gt�v �r , h I"� �r �i`t�t 9��o?t�k0
v�-t�oQ;�, c�.s� ! A�t�,�r,f i ��
S�ru s"z- :
Phone Number: Cd� 2-23-- 1� Z Fax Number: �6�� Z 23 -( C f .
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�B �Irs�-- S3q�zC��
AST lnstall Tanks Upgrade Tanlcs
UST � Remove Tanks � Upgrading Piping
Tank Ynfornxa[ion �#1 #2 #3 #4 #5
Comp4SitiOt] ��.��
TAn1c.Size `�j{Oc�
Contents �
Pipin� �-1-e c�
Approximate Cnst of Job: S � 3c�p
��_...f_.,.,.
Approximate Scart Date:_ �`.ti„�� � -�j ob 6¢-it�(
P�ernait Issuance Approval: '1f'es No
Conditions o;F Approval:
Permit Approved by: pate:
'Tank Systetn Fee d .aa Flans Revicw Fee PERMiT FEE: ,(t30,DC�
Note: This is not a permit. To obtain the�required permit,present THIS CFiECKL1ST,along with a 51`f�.PLAN and
a CHECK made payable to the"CITY OF US�-IKOSH"for#he amount listed in PERMIT FE�, to tl�e Building
Inspectors Office, Itoam 2p5 at City Hall, between tkze hours of 7:30-8.30 a.m. and I2:30-1:30 p.m. or by
appointn�ent (920)236-5045. This City Permit shail be obtaimed and on site�riox to commencement of wark.