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PLB. 68 DEPARTMENT OF HE, .LTH AND SOCIAL SERVICES <br /> Division of Health 14019 <br /> FEE $10.00 P.O.Box 309 NO. <br /> (1 Permit per Tank) Madison,Wisconsin 63701 <br /> Date Issued 9/2Z/73 <br /> Tank Size 750gal. 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 (Blue)-DI isi neer ofiHealth <br /> Public and/or permits. (Canary)-Issuing Agent <br /> Owner's Name Owner's Address <br /> Neil v< rren D&nWry, wl 54830 <br /> Location(Legal Description) of Property.Where Tank Will be Installed County <br /> S-E 3 a "f'+ ji1 l u=x > sT SZ Burnett <br /> Plumber's Name License No. Address <br /> ?iolaerick 1x *irw, : ;? U3G59 �kabst:ei�,r, W1 54593 <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> ; -3s tear, ..JZ 1-4893 <br /> Address of Issuing Agent(Town, Village,City) County <br /> 46)ste r', '•rel 54893 14.IrI1ett <br /> Title: Signature <br /> 3r. i ri,_i PdAni atratol'' tr <br />