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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 /> Your sanitary permit may be reorwed before the oxprration Cate, and at the time of ionewal any new <br /> criteria in the Wisconsin Administrative Code will be applicable.- <br /> .. AIii. revisions to this I erw _.,. arrp .rec! y .he f,e, -.ulr.g a,".�oity A rev permit metb e :ed <br /> it three is a=:ha ge ycJhu :.y p ar.- z-yster' rI,aU r :'oma e waste ate, flow , r " _ be- <br /> �oor ; etc.',. dep! o" syster. o 'ykr of _sys!er <br /> ,brritted to the P I r t,. .° st 'aCon <br /> ..r.. -.evag<, <br /> ..... P whe:ieV '..2JS..1� : r �•. .. .. <br /> vT. tanllly lw"i 11'- <br /> �... Purprse of appI -_,tier Cne;, o rt: ..c 'e'wi is to! tanr ref;lat.erneni- recti! ne.,.Io i <br /> repair. <br /> I'✓ Type of system: check all approp^.ate- boxes �ependino c,i system type. Check experimental only if pi oient <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 ehambe- and holding tanks for this system. Check experimental approval only if <br /> tanks received experimental product approvai from DILHR: <br /> VII. Responsibility statement: lostalli ig plumber ks to fill name. Ilcer,se iurnbei with appropriate prefix le-g. <br /> MP. etc.), address and phone number. Plumber must skin application form. Fill in designer name if <br /> applicable, <br /> VI11Soil test Information. Certified so l tester's name -e-tlfic -hor nutahe• address and ��one number. <br /> IX County/Department Use Only <br /> Y. Comment area for ase by county or •esann giver whn =ppir;afon is disapproved. <br /> :--omitlete plans and specifications no� smalle than - '.1 .ncbes must he ubmitte:', tc the aaL� ,ty 7f)(- <br /> pian. <br /> heplan. must include the following- A; plot plan- drawn to scale or wlt'n ::omplete dimensionslocation o` <br /> holding tank(s), septic tanks' or other treatment tanks: buildlr'rg sewers wells; water mal-is/water service <br /> streams and lakes, dosing of pumping chamoersdistribution boxes soil absorption systems. replacement <br /> system areas a nd the k nation a the bu 'ding se^veL B donzonta and vert-(al elevation refe�ence points- <br /> :) complete sped;fications for pu,nps and controlsr nose volume, elevation differencesfriction loss, pump <br /> performance curvepump model and ourno nranufar'we.-, M cross section of the soil ab orpt.Ion system <br /> required by the county: E' soil test data on, a 115 form <br /> GROUNCDWATEt; SU'rt:.Kl' <br />