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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 newpermit 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 tp 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 owners name and mailing address. Provide the legal description where the system is to be <br /> installed; <br /> It Type of building or use served: If, 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 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 /> Vlll. Soil test information: Certified soil tester's name.. certification number, address,. and phone number <br /> IX. County/Department Use Only, - <br /> Comment area for use by county o, resaon given when applicatior is disapproved. <br /> omp;ete plans and specification_ r cmalie *Iran � _ 1 nchE sbbI itted 'c the ou — _ <br /> plant ^nisi includE the o' 7Elar drawn is scale or v, umpie' <br /> hold Ig tank's`.. septi-, tani,s o— : sI E. ,el .arks. <br /> Streams anb sakes: oosln r. p,. =.one _ dirr,h ar b^<� _ _ •e.. - <br /> sys° e_,= - .a' c s- _. ? _ - ^.,rte . <br /> _ SpeCItL aLpr io, ar cc n ' C" e I ;L III �h f i'frru 'P1, IG= <br /> (in Play <br />