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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 pioperly 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 (i.e. 10 unit apartment, 30 sea', <br /> restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; <br /> III. Purpose of applicationCheck only one in 41. 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 a//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 number <br /> IX. County/Department Use Only: <br /> X Comment area for use by county or resao- g,ven whea application is disapproved. <br /> _,oni�.ele pians arc specifcat o-- i:, s•r.as;e, tr,a^ E':- aches ...-.'_ ne submitted tc <br /> plan )_s+ -,cl. e I,, ion ri _ �;ac. drawn a s a�t or w�t r :.omple' ec _ ,-atr ., <br /> !:Old "g Cant '> 'd <br /> gf.ea— 3n^ <br /> biF <ne fi :rl ren- i _ gr .rpt c �`.Se r ,h, Ii r <br /> Perlam u.0 CUr-'`. Il ,iJ ;tai . O. a.. 1!v L' S�G 1 C t) . <br /> equ e, o" Ic you e . 'o. <br /> .M! a. <br /> I <br />