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PLB 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of«e"n, NO. 14008 <br /> FEE $10.()o P.O.Box 300 <br /> (I Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 8/15/76 <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 (Blue)-Division of Health <br /> Public and/or permits. (Canary)-issuing Agent <br /> Owner's Name Owner's Address <br /> John Truhler WI 54830 <br /> Location(Legal Description)of Property.Where Tank Will be Installed County <br /> HE Ml gDC25 T4(Td z217sd t�tTOP: t <br /> Plumber's Name ucense No. Address <br /> Fbdelfick .4q*ins )9PRSW 03059 n 893 <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> Webster, W''I 54893 <br /> Address of Issuing Agent(Town,Village,City) County <br /> Webster, WI 54893 t <br /> Title: Sip an-= <br /> Zonitr3 Administrator <br />