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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> ' Division of Health r- <br /> P.O.Boz 309 0rr <br /> FEE $10.00 NO. G U 1 8 <br /> (1 Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 5/io 0 <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 /> not exempt installation from state or local approval (Pink)-Tank Retailer <br /> (Blue)-Division of Health <br /> Public and/or permits. (canary)-issuing Agent <br /> Owner's Name Owner's Address <br /> H. F. Brown =''0 C r'rlel' ,r. , srt Brighton, �Id 55112 <br /> Location (Legal Description) of Property Where Tank Will be Installed T� t <br /> nty <br /> SE ME SECTION 16 T40N R17W1 <br /> Plumber's Name License No. Address <br /> Don Daniels 330 1 Siren, W1 <br /> Signatu e'rof Person Qbtai ', Permit Address if Other Than Owner <br /> Siren, ld <br /> Address of Issuing Age t(Town;Village,City) County <br /> Webster Burnett <br /> Title: Signature <br /> 7.Onin1, Jld-linistmtor <br />