Laserfiche WebLink
pLg t_.(g' 4t.", DEPARTMENT OF HEAUR AND SOCIAL SERVICES <br /> Division of Health No. 35654 <br /> FEE S 1.00 P.O.Box 309 <br /> (1 Permit per Tan4) Madison,Wisconsin 53701 <br /> Date Issued 7 6 <br /> Tank Size gal. STATE SEPTIC TANK PERMIT <br /> Copies: <br /> Private Res. S 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 /> Maas 9729 Colfax ave. 301 BIOCK ngl Ons tuft 55420 <br /> Location (Legal Description) of Property Where Tank Will be Installed County <br /> EMEM <br /> Plumber's Name License No. Address <br /> HOPS XFM 03059 "STEB, WX %a" <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> ;M iTE3 41 54&93 <br /> Address off Issuing Agent (Town, Village, City) County <br /> +,�...M., I1 54M BUFJA= <br /> Title: Signature <br />