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PLR. 68 OEPARTMENT OF HEALTH AND SOCIALSERVICES <br /> FIiE 81.00 <br /> Dinenianof Nealth t NO. <br /> P.O.Bo.309 290 <br /> - D 99 J <br /> (I Permit per Took) Madison,Wisconsin 53701 <br /> Date Issued 6&Ab— <br /> Tank Sue_750—gaL STATE SEPTIC TANK PERMIT <br /> Copies <br /> Private Res. x This permit is for purchase of septic tank only and does rvvnuepPropeov Owner <br /> not exempt installation from state or local approval IPml.l-rant. or terve)rind,on of Nmua <br /> Public and/or permits (canar e). sAulny anent <br /> Owner i Name Owner's Address <br /> IEONM D= I Hamte 2 River Falls BI 540 ' <br /> Location (Legal Description) of Property Where lank Will be losmlled County <br /> SUF= <br /> Plumbci s Name License Na. Address <br /> HOME= DOPSIIS !'1HI�'aD. 03059 HF UII, DI 54893 <br /> Signature of Parson Obtaining Permit Address if Other Than Owner <br /> /� /c�c t. ,� F�tsTc+6 vI 54893 <br /> /Address of Issuing Agent ('Icon. Vulage.City) coumy <br /> 'Due, signalnre /� <br /> zoimx aD�ussa/ireH /)//'/i,//// /) !/�A� l/s,v/ �I' <br />