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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 tine expiration Cate, and at the time of renewal any new <br /> criteria In the Wisconsin Administrative Code will be applicable: <br /> - All ;evlsions to this permit mus', be apprcved by the perp,:! 1, Sr), a thurity. C new porn + may t.c r=,to <br /> If Thr-. e ,s a change n yo.l b,.ild '1�4 ;)!at = sps er, loan r .�rr.are , wastewate, flow r asti=r ^.f bed <br /> rooms. etc 1, depth of systr T c: Pvjw of vst�n, <br /> .�Fn),Ie. it 1W .,d n� rt!1 <br /> f—brr ttec to tht w-.r,-,� n -std gat _�r <br /> bE p.lrllf .— Ly a oc- <br /> 4 , r r v.h-"le .CESY i <br /> 2 ,F Cr w: iao:ily dw, :,m; <br /> Purpose of ,idjp --i:10 Che.* Dry , e d', of f?->fo tf <br /> 'i, if permits for tank replacemcnzrewire„Ilon <br /> repair, <br /> IV. Type of systemcheck all appropriate boxes depending en system type- Check experimental only if project <br /> is in conjunction with University of Wisconsin, <br /> V. Absorption system informationProvide 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 chamber and holding tanks for this system. Check experimental approval only if <br /> tanks received experimental product approval from DILHR, <br /> VII. Responsibility statement. Install�.l,g plumber Is to fill in namelicense number with appropriate prefix (e-g- <br /> VP. etc.), address and phone number. Plumber must sign application form. Fill in designer name if <br /> applicable. <br /> VIII. Soil test information. Certified sol.l tester's name. certification number address, and.phone number <br /> IX. County/Department Use Only. <br /> X Comment area for use by county cr resaon giver wh-r application Is disapproved <br /> Cornolete plans and specifications not smaller than -._ - 11 inches must be submitted to the county. The <br /> plans must Include the following A) plot pfan. drawn to scale or with complete dimensions, location of <br /> holding tank(s). septic tank(s, or other treatment tanks' building sewers' wellswater mains/water service_ <br /> streams and lakes, dosing or pumping c'namoers. distribution boxessoil absorption systems. replacement <br /> system areas and the location or the buildinu served Bl horizontal and vwticai elevation reference points <br /> C) complete specifications for pwnps ano controls, dose volume; elevation differences: friction loss, pwnp <br /> performance curve, pump model and pump manufacturer, D) cross section of the suit absorption system :f <br /> required by the county, E) soil test data on a 115 fora <br /> GROUNDWATEt� SURChARGE <br /> N, .. <br /> t :. ....,..lef -. <br /> i <br /> te <br /> E v <br />