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1988/03/09 - SANITARY - SAN - Other
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14319
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1988/03/09 - SANITARY - SAN - Other
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Last modified
3/6/2020 4:04:11 AM
Creation date
10/3/2017 6:46:17 PM
Metadata
Fields
Template:
Property Files v2
Document Date
7/14/2008
Document Type 1
SANITARY
Document Type 2
SAN
Document Type 3
Other
Tax ID
14319
Pin Number
07-020-2-40-16-18-5 15-582-019000
Legacy Pin
020914501900
Municipality
TOWN OF OAKLAND
Owner Name
JEROME C PANKOW
Property Address
28766 E YELLOW RIVER RD
City
DANBURY
State
WI
Zip
54830
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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 permit 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 to 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 /> II. Type of building or use served: If public is checked, indicate type of use (.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 /> Vill. Soil test information: Certified soil tester's name,. certification number, address, and phone number <br /> IX. County/Department Use Only, <br /> X. Comment area for use by county J' *esaon given when appiicatio, is disapproved. <br /> tomo eLe plans and specifica:.orr_: ,, a,ie. .�-a. : _ 1 .,„t.e .s; ..b^ 1,,.' tr -1, <br /> plan n-s- .Clu':e " e f-, lo sra`;! V" orr ou <br /> ,a" a .'"so - <br /> hole t •?k's` . .o' : tanw <br /> stream_. <br /> an- ,ak=s ^sio _. arnr� < 'Ill <br /> requ E 'inr o� <br />
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