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INSTRUCTIONS
<br /> t_ A sanitary permit is valid for two(2)years.
<br /> 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
<br /> Wisconsin Administrative Code will be applicable.
<br /> 3. All revisions to this permit must be approved by the permit issuing authority.
<br /> 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD-6399)to be submitted to the
<br /> county prior to installation
<br /> 5 Onsite sewage systems must be properly maintained The septi; tank(s) must be pumped by a licensed pumper whenever
<br /> necessary, usually every 2 to 3 years.
<br /> 6 If you have questions concerning your onsite sewage sys'emcontact your local code administrator or the State o`
<br /> Wisconsin, Safety and Buildings Division. 608-266-38 S-
<br /> To be complete an-" accurate this sanitary perm!,applicat.ion must include:
<br /> 1. Property ��,ti:` _ _ `i car "�Q ="iG�,'�5. P-D gide the e,dal de r ,'f�U��= and pal, i8X `.J','}ber($) '? VJaerelnE`
<br /> SyStem is to De Instailed.
<br /> i:. Type of Duilds ng being server Cl-,e.,;.. Drily one ana compieie m of bedroo'r15 if `i cr 2 F,,,,rt;;IDwe:iinci
<br /> Ili_ Building use if building type is public, check all appropriate boxes that appiy
<br /> !V_ Type of permit- Check only one online A Complete line B i r permit is for lank replacement, reconnection, or repa ;
<br /> V Type of system. Check appropriate box depending on system type-
<br /> VI. Absorption system information_ Provice all information requested for numbers i through
<br /> t Tank information. Filt in the capaci ry of every new/or existing tank, list the total gallons, number of tani(s anti
<br /> r,ar�ufacture:`s name. nd,cate rirefa>>or site constructed and tare materizl. Complete for all septic, pump/siphon ars_;
<br /> holding_ tanks iorthissystem Cf,eck experimental appr. jui oniv : �anl-, '°'ceived rtaI produc?approv<s' Ircc
<br /> DILHR
<br /> V;;:_ Responsibility statemer`_. lnstalling p=urnber is ro fill in name, Lcense nu❑ berwlth appropriate pref,x fc I_ MP etc
<br /> address and phone number_ Plumber mus!sign appication form.
<br /> IX_ County! Department Use On!
<br /> X County; Department Use Oni;
<br /> �O'T1;Ji etc pans ani: s,^.eiJfic3of,s n, srrr l:e i 8t '. e ,I tuL' 9E_)'rie COi;1- _. The plan>
<br /> i'"iClUde'L'Cfe iOliO>AYlrft;: Aj pID pian, Qi aVti it Ucat;tai. 4'tf holding Yanrvt it, Septic
<br /> :(S}gC" Own Pr lrea' Tlerft id '.-C{ "1 Se'�< o!E, 's,vatel is i/;Md rSefvi ,tic^rt b and i rej, pump or si
<br /> an s; distil buticin `Uv�eS; so�� absoro[icin ,y,tems re pi uC en i ens- yc f-,, L e;:+ : of J ;,he iCcati( Of the building ServEC
<br /> G) hJ a.4n1._ cni7 vert (a' eleval;On i!- ,,nre pU ` S : .JS . t. } ; : JS' c
<br /> eie Jatian d,fferenCei p'. ,p pai-,t)r.l,,nCe c,t rVe: p.,mr1 mGtf 'i artd pump mor_� aC!.0 rF D? cross SeCtr C'l
<br /> ::f?rfe>6.i apSDFDU 6n ,yStem r "C'QUir'd by ❑le COUni 50, t2tiu ),,, a Or' a i i 5 form, aral . ; all SIZing inf-'Jrmatl
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<br /> GROUNDWATER SURCHARGE
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