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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of Health NO. <br /> FEE $10.00 P.O.Box 309 <br /> (1 Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 10/11/79 <br /> Tank Size 1200 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 (Binh)-Tank Retailer <br /> (Blue)-Division of Health <br /> Public and/or permits. (Canary)-issuing Agent <br /> Owner's Name Owner's Address <br /> Carl Anberts St. Rte., Spooner <br /> Location (Legal Description) of Property Where Tank Win be Installed County <br /> NE NE S=ON 21 T40N R14W I Lxunleltt <br /> Plumber's Name License No. Address <br /> Cecil Scribner MPRSW 3661 Rte. 2 Shell take, WI <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> / /. <br /> Address.of Issuing Agent(TownVillagfCity) County <br /> Webster Burnett <br /> Title: Signature <br /> Zoning Administrator <br />