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INSTRUCTIONS
<br /> 1. A sanitary permit is valid for two (2) years.
<br /> 2 Your sanitary permit ar ry be renewed before t!c expiration ;late, sed „[ the time of renewai any new
<br /> criteria in the NJiscons,r. Adltliris?rative Code will be applicable.
<br /> 3 All revisic,is r'is p,,,r ! .ust : �pplc',u9 'ry the permit rasuufy au L`,crlty.
<br /> 4. Changes in ownership nr plumber requires a Sannary Fermlt Transfer/Penr.wal Form (SRC 6399� to be
<br /> submitted to the county prier to-Installation.
<br /> 5. Onsite sewage systems must be !r,operny maintained. The berth tan-(s` must be pumped by a !:censed
<br /> pumper whenever necessary, usually every 2 to 3 years.
<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 Family Dwelling.
<br /> III. Building use. If building type is Public, check all appropriate boxes that apply.
<br /> IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
<br /> repair.
<br /> V. Type of system. Check appropriate box depending on system type.
<br /> V!. Absorption system Information Pronvide all information requested in #1 7
<br /> dll. Tank inloratation rII' it ! ap , l, �.;, r , ` e, l,¢,ia4 1, _. '.s+ th h tel Gal o ` rr_rmber �,
<br /> tanks and rranufaraurer s name. Inorr .a pr,.l.0 or site cunsu uctru ;nr atik material. C orro ate i( r :Tri
<br /> septic. purnpisiphon and holrLng tank., ' - .., ;. . -. Check e:• :q,proval of , f tanl, ; ,eceived
<br /> experimental product appr,val frrm. 0;ri4p
<br /> VIII Responsibility statement Installing nLrmher rs in fill v' came, Ilnensa ni,rnher with appropriate pretrx le e.
<br /> MP, etc.), address and ph, ri nrrrd„ nlumj.N, slur apriicab * r m
<br /> iX. County/Department Use Only
<br /> X County/Department Use Only
<br /> Oomp!ete plans nch"' tW -r,I-i ri ,r! - Thr` re mw The
<br /> `ri,ld t i„r,,. - -,vata- sarvrre.
<br /> Streams aOd @kes pVDgi nr ,nhn, r.nk. ..... f ..,. ,,, vu. .,n ............ .vvr.+n,c reni., F+rr+w .,Nin
<br /> dIeas Jr - I I t'l ,In,s1.^n �ferP'.^P fJo_inr>
<br /> C? complete specifications for pumps tro conuuis; J.,s,, r!urn,. etevatim d,lrerenceis; f(rc or ;osm
<br /> s, pup
<br /> performance curve; pump model and pump manufacturer, D) cross sectlon of the soil absorption systern II
<br /> required by the county, E) soil test data on a 115 form; and F) all'sizing information. -
<br /> GROUNDWATER SURCHARGE -
<br /> ?ti !"disc A�.: 410
<br /> `;D-03987In.I Hg
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