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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 tanks) 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 (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 /> 111. 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 /> VIII. 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 giver when application is disapproved. <br /> ,omplete plans and specifications not smalle thar r' • 11 inches :^us' be subm�tfed to me cc=�.nt)- The <br /> plan, must include the following 4) pioi plan. drawn to scale o• wlth _.omplete dimers s '.ocat,on o' <br /> hold ng tank`s) septic tank(sl o- Aie tp?atmentfanf.s b.illdlnc. sewe .. _ wale- ^•a''.^sfwate ser-ice. <br /> streams and lakes. dosing o., pun�prng cnarrmne.s. distributio^ boxes .ole 3c= rotio^ systems yep,ace^ier' <br /> system areas a„d t`_ ,at.;r ti nu 'din;, se,ve, B ) zc 17<1 'efo,e� c <br /> ('. c„n,p ore spe2iflcatlons for p w ins and conf,ol5 dose VOILME IPV 3t qir d Nr ra l;;es `n"t Oo iOcp n 'nr <br /> pedOrrnanGb -urve ITGde: and ]j^Ir ' .,tar u•e _ CrOSo sect'0i- v 0-�, Vs!<e r <br /> requi,ed by the .oun,) E. so tc3 i <br /> cotnnlonl,• r ., a - . <br /> •i�5a it <br /> ,.iacicJ <br />