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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division P O0 of 3alth 21489 <br /> FEE $1.00 P.O.Box 39 NO. <br /> (I Permit per Tank)���� Madison,Wisconsin 53701 <br /> Date Issued 1111075 <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 /> ALZO SPCOUR, 50301 <br /> Location (Legal Description) of Property Where Tank Will be Installed -County <br /> NilZ SEC21 MON EI4W ACTT MOM <br /> Plumber's Name License No. Address <br /> r,s„ ._7 104. Hf?P___ NW U3059 wzasnat II5093 <br /> Skgi ature of Person 9. aining Permit Address if Other Than Owner <br /> jr 4< r RHS'TER, DTI 54893 <br /> A dress of Issuing gent (town Village,City) County <br /> AMER15 ZTT <br /> Title: Signature <br /> MEM Aram �, <br />