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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of v selth 20549 <br /> FEE $10.00 P.O.Box 309 NO. <br /> (1 Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 12/18/78 <br /> Tank Size 750 gal. STATE SEPTIC TANK PERMIT <br /> Copies: <br /> Private Res. x This permit is for purchase of septic tank only and does (White)-Property Owner <br /> (Pink)-Tank Retailer <br /> not exempt installation from state or local approval <br /> (Blue)-Oivislon of Health <br /> Public and/or permits. (canary)-Issuing Agent <br /> Owner's Name Owner's Address <br /> .;ary Ibbinaort I Route 16 I*= 386, Solon Springs, WI 54873 <br /> Location (Legal Description) of Property.Where Tank Will be Installed County <br /> 11r SE SW29 `P41F} A16v. SWISS Burnett <br /> Plumber's Name license No. Address <br /> i xx3erick 1fr kcir>~s MPRSW 03059 aster, to 54893 <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> Wlebsb W r WI 54393 <br /> Address of Issuing Agent(Town,Village,City) County <br /> Iddmatere WI 54893 tturnett <br /> Title: Signature <br /> Zoning Administrator <br />