Laserfiche WebLink
PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of Health 23165 <br /> FEE 51.00 -- P.O.Box 309 NO. <br /> (1 Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 4/2J/78 <br /> Tank Size 75() gal. <br /> 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 /> (Flue)-Tank Retailer <br /> not exempt installation from state or local approval <br /> (Blue)-Division of Health <br /> Public and/or permits. (Canary)-issuing Agent <br /> Owner's Name Owner's Address <br /> Euyerlc 1cCa 'rthy 4R 49b v. ';cCarron �.Iv '>., 5t, P-aul., `4` X511' <br /> Location(Legal Description) of Property Where Tank Will be Installed County <br /> SE NN 5EC24 T40N 81511 JACKSON urnett <br /> Plumber's Name License No. Address <br /> RodericLc `4,)pkina !+FfIS;! !3! 5°) ;.- I 54693 <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> Address of Issuing Agent (Town,Village,City) County <br /> ._` .- ter, !I 54c_ 3 ''�,rnr,tt. <br /> Title: Signature <br />