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PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of Healtht- <br /> FEE $ 0.00 P.O.Bo;.309 NO. 5 0 3 <br /> (I Permit per Tank) Madison,Wisconsin 53701 <br /> Date Issued 5/23/78 <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 (Blue)-Tank Retailer <br /> (Blue)•Dlvislou of Hearth <br /> Public and/or permits. (canary)-issuing,agent <br /> Owner's Name Owner's Address <br /> xxlvin Webb LAke, `Isl 54892 <br /> Location(Legal Description) of Property.Where Tank Will be Installed County <br /> NE W- SECI T40N R1511 3ACRSCt; Burnett <br /> Plumber's Name License No. Address <br /> Ronald Proffit RSV- 03072 Dairylatsd, WI $4830 <br /> Signature of Person 04hining Permit Address if Other Than Owner <br /> iryland, WI 54830 <br /> Address of Issuing Akent (Town, Village,City) County <br /> Webster# U1 54893 urnc-tt <br /> Title: Signature <br /> Zoning Administrator <br />