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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of Health 53795 <br /> P.O.Box 309 N0. <br /> Madison,Wisconsin 53701 <br /> Fee Paid $ U00 <br /> (Each Septic Tank $1.00) STATE SEPTIC TANK PERMIT <br /> Copies: <br /> Property <br /> Date Issued This permit is for purchase of. septic tank (Blue)Ta k Ret tler <br /> owner <br /> only and does not exenpt installation from (Canary)-Division of Health <br /> state or local approval and/or permits. (pink)-Issuing Agent <br /> Owner's Name Owner's Address <br /> EEMM CO DiQ.%N 3F0=1 AIXIMIN <br /> 3516 Z_WLocation (Legal Description) of Property Where Tank Will be Installed County <br /> XCTT n a =0 19 TUX RW Fr 11Tt <br /> Plumber's Name License No. Address <br /> Ie � 00310@321as =005M <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> Address of Issuing Agent (Town, Village,City) Coin <br /> IN <br /> Title: Signature <br /> 7. t <br />