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INFORMATION u 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 renewei 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 perm„t issuing ;,,,thnrity A new Permit may be needed
<br /> if there is a change in your building plans, system !ocatior estimatrn wastewafe-flow ;number of bed-
<br /> rooms, etcl. depth of system, or type of system:
<br /> 4. Changes in ownership or plumber requires a Sanitary Permit Transfer,;veoewal Form (SBD 6399) to be
<br /> submitted to the county prior to installation;
<br /> b. Private sewage systems must be properly maintained. The septic [ankls} ;,:iouid be pumped by a licensed
<br /> Pumper whenever necessary, usually every 2 to 3 years,
<br /> 6 ''f you have questions concerning your private sewage: sy res -snta,-r ,our iu 'al code admmistrato- nr the
<br /> State of Wisconsin. Bureau of Plumbing, 608-266-3815.
<br /> To be complete and accurate this sanitary permit application most include.
<br /> I. 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: It 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 92 it permit is for tank replacement, reconnection or
<br /> repair,
<br /> IV. Type of system check all approprate boxes depending on system type. Check experirnental only if project
<br /> is in conjunction with University of Wisconsin:
<br /> V Absorption system inforwat,on. Provide all informahnn requested in g1-6.
<br /> VI. Tank information rill In the capac:4y of every n,2w and ror e R„tmy tank ist the ,gra gallor_, 'c Ge installer'.
<br /> number of tanks and manufacturer's nh
<br /> ame. ,dicato prefe cr site Constricted and tank material Complete
<br /> for aN septic.. I ft,siphon chamber and hold,,, tarika fr; !I-, s systen•. r s c� ;xperfmental approval only it
<br /> tanks received experimental product approval from DILHR:
<br /> Vh Resp n ibilit)r gaternent. In-,tallir.g pfwnber s 9:; fill in oarre_ ilcensc r crr,ber with a! pr.:;i, ate prefix ;e g
<br /> MP, etc ), address and phone number. Plumber must sign application form Fill in designer name if
<br /> applicable.
<br /> Vlh Soil test information. Certihn(: soli le. t.is narni certification number, sodress. jr.,r ;tliciie nuvber.
<br /> IX. County/Department Use Only,
<br /> X Comment area for use by county or rfi given when application is disapproved
<br /> Complete plass, and specificat�uns not smaller l^.r rs.l 1 r n . h', '1 ,t be subs i»ed tc r .:;r;tit•,
<br /> plans -u.s' .11-!ude 1f e fnll-,v rig- A! '.;t plan. .. _ nla r cit- d tie '! 0 aricr :.
<br /> ho'dirc, ra^t'-'.. ,P ti- 'a,k ) : nt„� .t,...,r.,. - ser,..r .vnas. Nater ^srwarer se_.�,,_r.
<br /> streams and lakes_ dusrng or i, mr...)g c narnDer� 'rslnbuht ar i,u xes, so•. absorirtiun sysrrms reply ,yment
<br /> ire .r id ..c'; ewatinn rete carie Ooin1S'
<br /> C; -u tip„ to specifications for pumps and conirois. dose volurne: elevation differences. ft icnon loss. pump
<br /> performance curve. pump model and pump rya {acture: D) cross seubon of the soil absorption system if
<br /> required by the county E) soil test data on a 115 form ,
<br /> GROUNDWATER SURCHARGE
<br /> On May 4, 1984 1983. Wlscor, w Ar 4.;1 'I, s slyrer: 4io law 1 ieyislahr r. is more
<br /> .. S
<br /> .am iJi Ir , dltii)c.S . .ISr.. Jv vllui Wnu.nq
<br /> i .I t r' d _ r pYrutxzg
<br /> mat i, 9`ouii�wdrur c .,r I .r iai t � v� _L il c n . anJ o a` ,11 , _ i
<br /> it's worth protecting
<br /> SBD6398(R 03/86)
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