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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Diyision of Health i7-- r <br /> FEE $10.00 P.O.Box 309 NO. <br /> J 1 �F <br /> (I Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 7/17/78 <br /> Holding <br /> Tank Size 2000 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 /> (Pink)-Tank Retailer <br /> not exempt installation from state or local approval (Blue)-Division of Health <br /> Public and/or permits. (canary)-Issuing Agent <br /> Owner's Name Owner's Address <br /> Eugene Neubauer 137 E. Paye St., St. Paul, HN 55107 <br /> Location (Legal Description) of Property.Where Tank Will be Installed County <br /> Prix NW SEC29 737N 818V Tracie Lake Burnett <br /> Plumber's Name License No. Address <br /> SjOna1:3 Puniels 5(P 330 Siren, WI 54872 <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> Si; en, WI 54872 <br /> Address of Issuing Agent (Town, Village,City) County <br /> webster,t,I 54293 Burgett <br /> Title: I Signature <br /> Zoning Adrainistrator <br />