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INSTRUCTIONS
<br /> 1. A sanitary permit is valid for two (2) years.
<br /> 2. Your sanitary permit may ho renewed beton; the e=p,iation date. ;,,;d ;rt th< erne of renewal any new
<br /> criteria in the Wisconsin Adnlin,strabve Cod- wr!! be a;.,piicable.
<br /> 3- All revisions to th perry-if r ❑, b, apt ,vr•d i lv permii ,ssu,og authority
<br /> 4 Changes in ownership or plurnue± requires a Sa utery Perri• t rsosferlFerlewal Form (SRD 639B- to ee
<br /> submitted to the county prier to installation.
<br /> 5 Onsite sewage systerns musi be peoperly ntanrta•,led. ThF gfil, tan: - nuat t'a pr❑sped by A ,.l `,',I
<br /> pumper whenever necessary, usually every 2 to 3 years.
<br /> 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
<br /> State of Wisconsin, Safety & Buildings Division, 608-266-3815.
<br /> To be complete and accurate this sanitary permit application must include:
<br /> I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
<br /> where the system is to be installed
<br /> 11. Type of building being served. Check only one and complete # of bedrooms i` ? or 2 Family Dwelling,
<br /> III. Building use. If building type is Public, check all appropriate boxes that apply.
<br /> IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
<br /> repair.
<br /> V. Type of system. Check appropriate box depending nn system type.
<br /> VI. Absorption system information. Provide all int^rmaPoe requested n }4?-%
<br /> Vil- Tank info mahnn ,P:e . .,gin , t'r.l
<br /> tanks and manufa,Aurer's rattle Indicate r)i of tial l,nrsi uc_ n ' :ank io eriai ( nmp4 Ir Ili
<br /> septic, pump,siph,w and holding tank:. i j W. Check c x,�, 1 11: porovai o it tafiks :eceive(:
<br /> experimental product approval fret; n',LW
<br /> VIII. Responsibility statement Installing pir,nrh-, l0 I;.. ,,, flame ;It e,te 1"miller With as,prof,riate prefix ie „
<br /> MP, etc.), address an : phone ,.r` :xrr P, ..r,fie; it ,wr appn def r. (-_.,,-
<br /> IX. County/Department Use Only.
<br /> X. County/Department Use Only
<br /> Complete tdan, ,1111 r. .'. r,rhs,._ r'.,� t , �r;:n _ the r..Ln'v. ThF
<br /> plans r;u.,f nn -r with a*iq". Of
<br /> rl,ddillg t:, in ,('f: v fr-r iervice:
<br /> streams dnU rail" 111U„n lq c11Jn,nl rMT .nn a In, Ina,Yl vi nim n nl ,v III. f u
<br /> . -�lr r-1,11.Y,I IYI �Y.\lelll
<br /> al Cit••. :".r:
<br /> ! r >I ... - .rPV^tl',C rl?fF^.rF�.trP ,,Clnr
<br /> C) complete specil;ca:ons for pu!r ps and _,)nirc,s JIsp 3'evst. )r :Lfiererces, hlct!on loss, pump
<br /> performance curve: pump model and pump manufacturer, D) cross section of the soil absorption system t
<br /> required by the county, E) soil test data on a 115 town, and F) all sizing information.
<br /> GROUNDWA7-ER SURCHARGE
<br /> 1969 W,sIons,r rtr f • iu , .1:n It.
<br /> SBD-6398 (R 11/88)
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