ALARM PERMIT
(Application)
Date:
Permittee:
Address: Phone:
Signature of Authorized Person:
TYPE OF ALARM:                      CENTRAL ANSWERING STATION
                                                                           ON-PREMISE
ALARM COMPANY SERVICING:
Name:
Address: Phone:
BRIEF DESCRIPTION OF AREA TO BE ALARMED:

Emergency/After Hours Contact

Name:  __________________________________  Phone Number :__________________

2nd Name: _______________________________  Phone Number :__________________

APPLICATION APPROVAL
Date:
Person Approving Application:
Amount Collected:
Informed of Ordinance and Policy:                           YES
                                                                                    NO

Mail to:  Wood County Sheriff Department  400 Market Street Wis Rapids WI 54494
Along with your $25.00 application fee.