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INSTRUCTIONS
<br /> 1. A sanitary permit is valid for two (2) years.
<br /> 2. Your sanitary permit may be renewed before the E xp;ration date, and at the timn of renewal any new
<br /> criteria in the Wisconsa/ Administrative rude will be apPiicable-
<br /> 3. All revisions to this per nil ITlust bc, }pp„oved s,y II!e permit issuing authority.
<br /> 4. Changes in ownershq, of Plumber require. a Sanitary Permit Transfer/[genewni roan (SRR
<br /> submitted to the county prior to installation.
<br /> S. Onsite sewage systema must be prooerly maintained Thr, S- ,;w te,fKrs) flit-,r be pumped b
<br /> pumper whenever necessary, Usually every 2 to 3 years y j senseu
<br /> 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
<br /> State of Wisconsin, Safety & Buildings Division, 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 and parcel tax number(s) of
<br /> where the system is to be installed.
<br /> II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Famil
<br /> III. Building use. 1f building type is Public, check all appropriate boxes that apply y Dwelling.
<br /> IV. Type of permit. Check only one in line A. Complete line 6 if permit is for tank replacement, reconnection, or
<br /> repair.
<br /> V. Type of system. Check appropriate box depending on system type.
<br /> VI. Absorption system information Provide all information -equested in #1-7
<br /> VII- Tank information F " I t c .;ve
<br /> tanks and ma n' r re s nanfa. i t), t r I „ snd (Nr ` .stir , ' st fin. Ictal
<br /> oc,.. Hurt h, - ,f
<br /> Septic, puna I „r P I site umstruct .nf anK material Cornp;e!. i9
<br /> f and Holding tank, f:,r fl .f,-LI. Check expo imenta r I -, , , -<iFrI ex " E-''' :;Iaruval ,e- a r
<br /> viii- Responsibility statpme It ,crylii,u, olurr he, Is Io fill nr n-rmP iu-e�sF nunll)t" with appropriate pr rile r., y
<br /> MP etc.,, add i s a r; n r un i r P un.
<br /> IX. County/Department Use On IN <.at , f. .m
<br /> X. County,Department Ilse Only
<br /> Cnmpletel.rvr -
<br /> olans r ust ur b, tl the r,l:n!V The
<br /> Streart illfl iHkr, -
<br /> .
<br /> fl:: .I i i .i rel i� I it �Irl
<br /> C) c)mPIE to aper Icc o 's f nun ,I
<br /> u E i r S J F
<br /> performance curve f ""P me rrolPclmp and es, n IUrt c
<br /> � i tai ... ,E I.1 rOSc h ir. �r
<br /> required by the n
<br /> count , datae s illhsr,rptl, ;.
<br /> Y. ) soil lest ur, a 'c,r r
<br /> 115 u ar c' P) al( srz r � Information.
<br /> GROUNDWATER SURCHARGE
<br /> 983 Wiscc n irl Ac ^!n
<br /> SBD-6398 In,11/88)
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