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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 /> It Type of building or use served: If public is checked, indicate type of use (i.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 system: check 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 all 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 /> VIII Soil test information. Certified soil tester's name, certification number. address, and phone numbe . <br /> IX. County/Department Use Only, <br /> Comment area for use by county or resaon giver when applicatloa, is disapproved. <br /> �om_ilete pla— ,nd spe if cz;'o-s srr.alle ftdn ' _ 1 ch _ ae submitte.'. tc _ <br /> p'a = ^gust io_iLJ­`- the fc !0"n- at r;ot =lar d"a�•. '.c scale or wt.rh "omple'- d -nersw <br /> tdnf s` `,ep'': ranr <br /> SfrParpc inn �.?k. c �^,. or' _.n' _ -�h n^ 3�,< r.�Y n^ •�••• -�•• o - <br /> _ IF 5,�r iL. S.In• - � � i. ar Pr '.9e ma .h,.^ � k ca r.a. . r.._ , <br /> i <br />