HomeMy WebLinkAbout0075043-Storage Tank (remove) - � CITY OF OSHKOSH No 0075043
OSHKOSH STORAGE TANK PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1005 E NEW YORK AVE Owner DENNIS B/LYNDA J LORD Create Date 01/10/2000
Contractor A&D INDUSTRIES Category 281 -REMOVE STORAGE TANKS
Tank Type Metal FiberGlass Tank Size 1000 Tanks 1
Service Install Remove � Above Ground______ � Underground ___,
Contents ✓ Petroleum Solvent Natural Gas
Kerosene � Liquid Petroleum Other
Use/Nature emove 1-1000 gal fuel oil storage tank.
of Work
Valuation $60 00 Permit Fee Paid $100.00
Issued By: Date 01/10/2000
� Permit Voided'
In the performan�e.of this work I agree to perForm all w rk purs nt to rules governing the described construction.
Signature � � � Date ' / 2t�o L�
AgenUOwner
Address 1005 E NEW YORK AVE OSHKOSH WI 54901 -4028 Telephone Number
1-B7-2aB d:3BPM FROM OSHKOSH FIRE DEPT. 9282365295 P. 1
.
' US"T/AST PCRMIT CHECKLIST
Job Site Address: QD,.� C �L W �.�� ,
Contractor: ,� ,V �S
Address: 0 D � �
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Phone Number: i – j'– L � Fax Number: 7js� �,,r,r= �7��'
AST Instal Tan�cs Upgrade 7anks '
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UST ✓ Kemo e Tanks ! Upgradin�Yiping " � n T
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Tank Information #1 #2 #3 i�4 #5 � �
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Composition � ~
Tank Size T � � � o
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Contents =
Piping , .
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Approximate Cost of�Job: - n, n�
Approximace Start Date: / Z pv v � � �
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Permit lssuance Approval: Yes___ No (�
Conditions of Approval:_
Pecmit Ap roved by: �� . � Date: `
Tank System T��Plan �ew Fee �--� PERMIT FF_�'� ,�L
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Note: This is not a permit. 'fo obta n the required pem�it, presenc Tl�1S CHFCKLIS'T, along with a Sl7�G !'LAN anJ
a CHECK made payable co the"CC Y OF USHKUSH" for the amount listed in Pl;[Zlv1IT FL;L, tu the B�utding
Inspectors Offtce, Room 205 at Cit Hall, between the hours of 7:30-8:30 a.m. and 12:30-1�3U p.m. or by
appointment (924) 236-5045. "fhi City ['ermit shall be obtained and on site pcior to c:omtnencement of wor�C.