Laserfiche WebLink
PLB. 68 DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> Division of Health <br /> FEE. lP.O.Box 309 NO 1755 O <br /> (I Permit per Tank) Madison,Wisconsin 53701 v <br /> Date Issued 10/18/74 <br /> Tank Size 750 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)-Division of Health <br /> Public and/or permits. (Canary)-Issuing Agent <br /> Owner's Name Owner's Address <br /> Robert Plaisance 1 3733 261 Ave. 'I., r ipls., IVI <br /> Location (Legal Description) of Properly Where Tank Will be Installed County <br /> SW 1/4 Section 15 T4% 8154 I LurIllett <br /> Plumber's Name License No. Address <br /> r onald Proffit MPROW 03072 Dairyland, WI <br /> Signature of Person Obtaining Permit Address if Other Than Owner <br /> Dairylmd, 4 <br /> Address of Issuing Agent(Town;ViLlage,City) County <br /> 'Webster 3urnett <br /> Title: Signature <br /> Zoning Administrator <br />