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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 /> Your sanitary permit may be ren-wed before the expiration dateand at the time of renewal any new <br /> .riteria in the 'Wisconsin Administrative Code will be applicahle, <br /> All rrv[siors to this {.ern . r,us! Ue approver3 -:y .he t,e 7 t sun�3 =it} P ne.v permit may be r ", <br /> th_ -e is a change r,. y t.r ,.I p'.a�s s}_t_ als, e_tio.at t wastewater flow ml_., of be- <br /> ,,)on a etc ;. drptti of systemr:, typ sysL.:r,. <br /> =;hr r.e3, p ',d nt)r. Ie.{u .a <br /> suhrr, ttcd tc the ,.rty prici to ^ata Iatlon. <br /> "rib rw „�hcyu �ysfr:,s r �„ „ vet .y •r�-�Irdwli:. .. _ _ .a. 71e <br /> .� Al r <br /> imr;or C' _ r _ W drplh `Nr 'Inc <br /> _ r3nrpj c Ot apphcaliun 'Criec- oil', 'C {�'. ,( Ir :;_H at Ii Je!II II 1 JI to lr. re[. ._iomenL rCJpn'.eC :OII O: <br /> repair <br /> Type of systemcheck all approf:riate boxes aepending on system type. Check experimental only if piojeci <br /> is in conjunction with University of Wisconsin <br /> V. Absorption system information. Provide all information requested in 41-6 <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 Installing plumber Is to fill it: name. license number witt 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 rest Infermation. Certified soil testers name- ce-tificaiior number. address, and phone number. <br /> IX_ County/Department Use Only <br /> X Comment area for use by county or resaon given whar- application is disapproved <br /> Complete plans and spe;;ifications not smalier than 8'. 11 inches mus', be submitted to the coajrry The <br /> plans must include the following A) plot plan. draw- ;o scale or with complete dimensions. location o` <br /> holding tank(s), septic tank(s or other treatment tanks; building sewers: wells. water mains!water service. <br /> streams and lakes, dosing or pumping chambers, distribution boxes soil absorption systems replacement <br /> system areas and the to .arson o` the building served. M nor.zontal and vertical elevation reference points; <br /> C'. complete >pecifications for pumps and controls. dose volume: elevation differences, friction Toss- pump <br /> pert r rndnce curve'.. pump model and pump r an racb,rer. D' cross section of the soil abs -p`.lor system <br /> required by the county, E= sc:i tea: data on a 115 form <br /> GROUNDWATEnSURCKARGE <br />