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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 servedIf 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 it 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 numbe- <br /> IX. County/Department Use Only, <br /> X Comment area for use by county or resaon g;ven wner application is disapproved. <br /> omplete plans and specificatiors no` smalie ta, '1 niche, rws- be submitted to <br /> plans must include f'-,e fol owln- q lot zlar drawn ro scale ar �'itt complete dimension- <br /> hold.,ng tanks) sept c farlkts' o- `erne- t'E-atmp. ar; . t Id 'IU F?W, _ .+c.'!. wa'e' —ri <br /> strea— and lakes; ons-,, '.n- ^ham^ Tc+nn .r O^ bnx-e e^ anc^•rl�ln^ wG.n •• q...,,. <br /> =ystE r ,ea- e r' t- D <br /> n sp P.Cifl:'at�Ot'S for �lrnn arl'I COM t nrce A oil rmn, a,'shr,n r'.i tir•rBnnPc f t:��. In<p rr,r <br /> perf,i vnanyc j: <br /> requrez� oy :he 0 _ se ro� aat$ . . <br />