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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> D✓ision of Health <br /> FEE $10.00 P.O.Box 309 NO. 5 5 2 9 <br /> (1 Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 6/15/78 <br /> Tank Size 1230 gal. <br /> STATE SEPTIC TANK PERMIT <br /> Copies: <br /> Private Res. l< This permit is for purchase of septic tank only and does (White)-Property Owner <br /> not exempt installation from state or local approval (Pink)-Dank Retailer <br /> (Blue)-Division of Health <br /> Public and/or permits. (Canary)-issuing Agent <br /> Owner's Name Owner's Address <br /> Vernon Dcsr,ct't Webster, WI 54893 <br /> Location(Legal Description) of Property.Where Tank Will be Installed County <br /> 144 NE t`sl G;l `"39ti Ia15 yllt:EN t: Burnett: <br /> Plumber's Name License No. Address <br /> Roderick Hopkins 1P h; 33059 t ebster, WI 54893 <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> Webster, WI 54893 <br /> Address of Issuing Agent (Town,Village,City) County <br /> Webster, WI 54593 Iurnett <br /> Title: Signature <br /> Zoning Administrator <br />