Laserfiche WebLink
PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> - ' `Division of Health �� <br /> P.O.Box 309 NO. <br /> Madison,Wisconsin 53701 <br /> Fee Paid $ <br /> (Each Septic Tank $1.00) STATE SEPTIC TANK PERMIT <br /> Copies: <br /> Date Issued This perwIC f l for purchase of septic t=k (White)-Property owner <br /> Mly and does not exempt installation f� (Blue)-Tank Retailer <br /> 1 ..�_t i. i (Canary)-Division of Health <br /> state or local ��?�rovaY and/or perialts. (Pink)-Issuing Agent <br /> Owner's Name Owner's Address <br /> Location (Legal Description) of Property., here Tank Will be Installed County <br /> Plumber's Name License No. Address <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> Address of Issuing Agent (Town, Village,City) County <br /> Title: Signature <br />