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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 permitmay 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 sdptic 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 /> !. 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 sear <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 if project <br /> is in conjunction with University of Wisconsin: <br /> V. Absorption system information: Provide all information requested in #1-6; <br /> Vl. 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 /> Vill. Soil test information Certified so,I tester's name, certification number. address, and phone rlumbe, <br /> IX. County/Department Use Only; <br /> Y. Comment area for use by county o, resaorf giver- when appllcatlor is disapproved. <br /> ,omolete plans and speclflcc' o, a sma'lel ' an <br /> - ,a SuLtrl ue„ tc .,,a. <br /> pla!'. must mcif 'c t'-e fo.riw,ng aw _ .,, l ie , <br /> . a s m t d <br /> G <br /> holdng !ank'si sept.:: tankrc n- "re t•e3t­�!r _ n <br /> St•eawn and !ai,-, o"', cC C`.. '4RI: _ •i r 1^ro e. <br /> F <br /> perf,_ Iri n .:Cie .i J.. <br /> requ cr. .�., 7nF c, , s,, .c <br /> r m It'd v :. <br /> :UIIIIiIOI. ' <br /> -C SII i. <br /> I <br />