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INSTRUCTIONS
<br /> 1. A sanitary permit is valid for two (2) years.
<br /> 2. Your sanitary permit may be renewed before the eq �tv, date:, enrt it the time of renewai any new
<br /> criteria in the Wiscoris ,Jrnini5rrat!er Code will be e,piieable.
<br /> 3 All e::Slons to th c per ii +-,ust rr y+Ftov. d , ii.� Fur i .s.,., y uc Clot ity
<br /> 4 Changes in ownership o, pk)mlyer requires a rrr r.. .SPO 64ai to D,2
<br /> subm tied to the owity prix, it Instaiiati:,rt_
<br /> 5 Onsite sewage systems must be, pu,periy >'ntamed he �,t be Vuwped by
<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 /> II. Type of building being served. Check only one and complete ti of bedrooms it 1 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 on system type.
<br /> VI. Absorp^ion system information. Provide an information requested +n 01 7
<br /> VII. Tangy: nforrratlrrn Fill h"i. t = r.ap.,.. _ _ .0±her x 1 .St the t, fl4-, r r.rarb rel
<br /> tanks and manufacturer s name. Indic pr: vi 5iie, uonsuuct, r ank mateltat I „n p F 9ii
<br /> septic, oumpys,pt ,,.. and ho!ciutg lark (;hr-.ck r,•, I �; provai c ecervec'
<br /> exper nr ontal pic , .! eI l ,el it
<br /> Vili Responsibility state--1 +ntita iina} (.in...h-, ti in k;; .rr.mher with g,.rlin)p riala r,rf.Ox f«. o
<br /> VP, etc 1_ addres, r
<br /> IX. County:Department Use Only.
<br /> X. County,Department Use Orly
<br /> Complete Alar .i slit- . < _ 1 -i: n1fr - r br thr �nrirty The
<br /> plans r lt.�t in �. ,. �. - - r u✓ith '.� v -. nti of
<br /> YireBnb slur rHkb. r„nut, n nr,., nrn+ ,,.Ir
<br /> ......... , r
<br /> r.,) corniiete spec 'ic'ri ons f,,, )it-, cal cunhC; ,, J ;S (r.uiy,c e'f vV&t r f ere:.(:es trio .cr . . putt r
<br /> performance curve, POMP model end p+rrdp manuf,ar,r, ,r r 11) ry oc¢ — r'"n ,it ti-,e soil ,hcnroti, r .. e:,, ..
<br /> required by the county, F) soil test data on 11, rr.rr,,, and F) alsizimy ,rformation.
<br /> GROUNDWATER SURCHARGE
<br /> 1983 Yd Sco, ;in Art 41n nri'.r
<br /> t . .. "t ' Nhir✓, ._�. .,kr.t �. r.,� y-t.,."
<br /> SBD-6398(R.11/88)
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