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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of Health <br /> 1( <br /> FEE $10.00 P.O.Box 309 NO. 117 7 1 <br /> (I Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 11/6/79 <br /> Tank Size 750 gal. 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 (Pine)-Tank Retailer <br /> (Blue)-Division of Health <br /> Public and/or permits. (Canary)-issuing Agent <br /> Owner's Name Owner's Address <br /> Robert Haffely 535 E. Annapolis, St. Paul, tfi <br /> Location (Legal Description) of Properly Where Tank Will be Installed County <br />!, M-1 SE SECTION 19T40 R16W I ;Arnett <br /> Plumber's Name License No. Address <br /> Rai Hopkins yPRSW 03053 Webster, WI <br /> Signature of Person Obtaining Permit Address if Other Than Owner, <br /> Webster <br /> Address of Issuing Agent (Town,Village,City) County <br /> rJebster ikirnett <br /> Title: Signature <br /> �.unirt4> ;;d:ainistrator <br />