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prcR.�by� '• ~'v DEPARTMENT OF HEALTH AND SOCIAL SERVICES' <br /> Division of Health - 15677 <br /> IFEE SI00 P.0:90a309 NO. <br /> (1 Permit pey0k Matliaon,Wisconsin 53701 <br /> Date Issued <br /> Tank Size-7150 gal. STATE SEPTIC TANK PERMIT <br /> copies: <br /> I Private Res. X This permit is for purchase of septic tank only and does lw 0-Property owner <br /> not exempt installation from state or local approval (Pink;Tanx Retailer <br /> lame;-Didalon as Health <br /> Public and/or permits. leaneryplssnlny Agent <br /> Owner's Name Owners Address <br /> Ed Hwmn AMM7t HI <br /> Lueahon(Legal Description) of Property Wberc Tank Win be Installed County <br /> CU =2 TTM R3JU HI3rwtt <br /> j Plumber's Name License No. Address <br /> Kermit Inrsam Wd 1075 7nck, H2 <br /> I Signature of Person Obtaining Permit Address if Other Than Owner <br /> Address of Issuing Agent iiT��own, Village,City) County _,t <br /> HebWr,sHI 54893 i91171HG <br /> Title: Signature <br /> A�dnistiutor <br /> i t, <br />