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PLg 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DlNdon of Health ND. 20572 <br /> FEE $10.00 - P.O.that o309 <br /> (1 Permit per Tank) Madison,Yls.ondn 63/01 <br /> Date Issued 4/17/70 <br /> Tank So, 1202PI. STATE SEPTIC TANK PERMIT <br /> copses: <br /> Private Res Y This Permit is for purchase of septic tank only and does Iwl,W-Property owner <br /> not exemptinstallation from state or locale approval (pine)-Dana Retailer <br /> PP Ialue)'.rk n of Health <br /> Public and/or permits. R:e.aryl-isswna AIM <br /> Ownei s Nun. Owner's Address <br /> Fred Reese I Brook Park K1 55007 <br /> Location(Legal De¢ription)of Property.When,Tank Will be Installed County <br /> NT SH IU ACXr at OPG .7 v+ <br /> — oa V' <br /> Plual Name license No. Address <br /> Fklderick Hopkins I-TRSti 03059 1 Webster, WI 54893 <br /> Signalun, of\Person Obtaining Permit Address d Other Then Owner <br /> Webster NI 5489 <br /> n lS <br /> Address of Iswing Agent(Town, Village,City) - County <br /> Bebster, WI 54893 Burnett <br /> Title: Sigsuture / / <br /> Zoning Administrator <br /> J <br />