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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 /> 1 Property owner's name and mailing address. Provide the legal description where the system is to be <br /> installed; <br /> Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 sea! <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 /> VIII. Soil test information. Certified sal tester's name, certification number, add,ess, and phone number. <br /> IX. County/Department Use Only, <br /> Comment area for use by countp o, resao� g:ver wher apal-catio is disapproved. <br /> _omplete plan, and spe iflcafo-s s�.allc � .� _ 1 ^.e c� submittec ,e `.ne +� •� ".f. <br /> play < res? ilc a � '.`'e fc.�io�n,ng .vt Diol plar. 7,iwr c. s3ale a r vompieTe o .,ens y ;.;at,u i <br /> ranks s _tank', n e <br /> s"earns ani <br /> i <br /> Ger rr A rde <br /> reqrt1-ec D\ 10e C --y =� sem" Z�; J,'._ <br /> UOP,I1YIJ" k' `! r _ <br />