Laserfiche WebLink
PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of Health r- <br /> FEE $10.00 P.o:-Box 369 NO. 5571 <br /> (1 Permit per Tank) Madison,Wisconsin 53701 <br /> Date IssueVl3/r78 <br /> Tank Size750 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 /> William McCann Star Route, Weimer, WI 54893 <br /> Location(Legal Description) of Property.Where Tank Will be Installed County <br /> SE SW SEC19 T4ON R14W SCOTT Burnett <br /> Plumber's Name License No. Address <br /> Cecil Scribner MPRSW 03061 Shell Lake, WI 54871 <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> f Webster, WI 54893 <br /> Address of Issuing Agent(Town, Village,City) County <br /> Webster, WI 54893 Burnett <br /> Title: Signature <br /> Zoning Administrator <br />