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PLB.68.. DEPARTMENT OF HEALTH AND SOCIAL"SERVICES <br /> Division of Health . 20123 <br /> FEE $)0:(Bj - P.O.Box 309 Nf, <br /> (I Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 4/24/80 <br /> Tank Site 1000 gal f STATE SEPTIC TANK PERMIT <br /> copia.: <br /> Private Res. x This permit is for purcha a of septic tank only and does IwmhePp.ope.ry 0-1 <br /> not exempt installation from state or local approval (pin¢PT+°` P`r'o` <br /> Inmel"olvlLon o' Hesne <br /> Public and/or permits. Ic+nnrFi+mina mens <br /> Overt s Name Ownels Address <br /> Theodore Kaye, Jr. Hebb lake, HI <br /> Location (Legal Deveription)of Properly Where Tank Will be Installed County <br /> SB SE SMIOW 2 TZION R14W Burnett <br /> Plumber, Name Ueenu No. Address <br /> Ben Bushey 2955 Siren, WI <br /> 5ignature of Person Obtaining Permit Address if Other"fhan Owner <br /> . Siren <br /> Addressge <br /> of Issuing Ant(Town,-_Illago,City) County <br /> Webster Burnett <br /> .Tice: signature .. <br /> Zoning Ai-rainistmtor A/ n . <br /> / <br />