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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT <br /> APPLICATION <br /> TO THE APPLICANT: <br /> 1. This sanitary permit is valid for two (2) years, <br /> 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new <br /> criteria in the Wisconsin Administrative Code will be applicable; <br /> 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed <br /> if there is a change in your building plans, system location, estimated wastewater flow (number of bed- <br /> rooms, etc.), depth of system, or type of system; <br /> 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be <br /> submitted to the county prior to installation; <br /> 5 Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed <br /> pumper whenever necessary, usually every 2 to 3 years, <br /> 6. If you have questions concerning your private sewage system, contact your local code administrator or the <br /> State of Wisconsin, Bureau of Plumbing, 608-266-3815. <br /> To be complete and accurate this sanitary permit application must include. <br /> I. Property owner's name and mailing address. Provide the legal description where the system is to be <br /> installed, <br /> II. Type of building or use served: If public is checked, indicate type of use li.e. 10 unit apartment, 30 seat <br /> restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; <br /> III Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or <br /> repair; <br /> IV. Type of systemcheck all appropriate boxes depending on system type. Check experimental only if project <br /> is in conjunction with University of Wisconsin, <br /> V. Absorption system information: Provide all information requested in #1-6; <br /> VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, <br /> number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete <br /> for al/septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if <br /> tanks received experimental product approval from DILHR: <br /> VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. <br /> MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if <br /> applicable, <br /> VRI Soil test information: Certified sol: tester's name. certification number, address, and phone number. <br /> IX. County/Department Use Only; <br /> Comment area for use by county or esaor given when appllcatior ;s dlsapp-raved. <br /> plan i; -no spe dca.,o- 1 sma�ie <br /> pilar est e f-- lrn'ry rai, JraN,, :L �_a.0 ._M1r h' ;-omp,e­ C i r,s,v _d¢ -. <br /> sf.00'M 5. 3'1'a k-.- ^Sin - 7n `1^Y - <br /> fi <br /> a <br /> ire f rcR(:b .,.r�< n ,6H'. v1 J._' err c".'_ �.tal. U• ry` ' - <br /> rin nriry - ' <br />