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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of Health ry <br /> FEE $10.00 P.O.Sox 308 NO. 5501 <br /> (I Permit per Tank) Madison 1yfisconsill 53701 <br /> Date Issued 5/18/78 <br /> Tanksizp. 750 pi. STATE SEPTIC TANK PERMIT <br /> copies: <br /> Private Res. Y This permit is for purchase of septic tank only and does (white)-Property owner <br /> not exempt installation from state or local approval (Blue)-Tank Retailer <br /> (Blue)-Division of Health <br /> Public and/or permits. (canary)-Issuing Agent <br /> Owners Name Owners Address <br /> Hors $ obloa Routa la Lake Slao# MN S5042 <br /> Location(Legal Description) of Property.Where Tank Will be Installed County <br /> Nq N8 SEC1S T40M RiSW JACKSON #21 Trout Springs-Voyager Vill Burnett <br /> Plumbers Name License No. Address <br /> Signature of 54893 <br /> n Ob ' Permit Address if Other Than Owner <br /> Webster#WI 54693 <br /> Address of Issuing Agent(Town,Village,City) County <br /> ttebster# WX 54843 Burnett <br /> Title: Signature <br /> Zoning Adslnistrator <br />