Laserfiche WebLink
PLB. 68 ' DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division309 of Health <br /> P.O. <br /> NO. 392 3 <br /> PO Box 309 <br /> Madison,Wisconsin 53701 <br /> Fee Paid $ 1a70 <br /> (Each Septic Tank $1.00) STATE SEPTIC TANK PERMIT <br /> 6/5/72 This permit is for purchase of septic tank Copies: <br /> Date Issued (White)-Property Owner <br /> only and does not exempt installation (Blue)-Tank Retailer <br /> from state or local approval and/or permits. (Canary)-Division suing n of Health <br /> (Pink)-Issuing Agent <br /> Owner's Name Owner's Address <br /> DAVE KUM MSS BIECINZI ST., STs PAULI MINNESOTA <br /> Location+y �(Legal Description) of Property Where Tank Will be Installed County <br /> t1lA la SSE SEC, 7 815 <br /> Plumber's Name License No. Address <br /> IL. =SANT 4631 ifill3C{ SIN <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> WISCONSIN <br /> Address of Issuing Agent (Town, Village,City) County <br /> WESTER, WISCONSIN <br /> Title: Signature <br />