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a <br />Checklist for Sanitary Pe>r snit Application <br />`o Address of Svsteni ZS % hq� f'�d`j G� <br />J <br />Ui 1\ <br />Submit the following (Permanent Ink) <br />anitary Permit Application SBD-6398 (1303/13) <br />Index Page/Title Sheet <br />blot Plan (Original Copy) <br />�Iross Section & Over -Head Profile of System <br />w'Contingency PlanlManagement Plan/Servicing Contract <br />it & Site Evaluation Report (In Office or Included) <br />Fee (Make Checks Payable to: Burnett County Zoning) <br />.e-,Pump Tank Diagram, Alarm & Pump Curve (If Applicable) <br />-e—State Plan Review or County Review (if Applicable) <br />--a Copy of CSM, Deed, or Tax Statement (Optional) <br />Sanitary Permit Application: (SBLI-0398 R03/13) <br />1. Application Information <br />2. Type of Building <br />3_ Type of Permit <br />4. Type of POWTS System <br />5_ Dispersal/Treatment Area Information <br />6. Tank Information <br />"IDATF STAMP" <br />D <br />Plot flan. (To Scale or To Dimension;) <br />o Signature and Plumber Information <br />Direction and Percent Slope <br />o Tank and Filter Information and Location <br />n Wetlands/Navigable Bodies of Water <br />o Surface Elevation of Body of Water <br />o Absorption Area (Proposed & Existing) <br />* BM (Location, Elev. & Description) <br />o Component Manual Version <br />Cross Section and Over -Head Profile of System. <br />o Surface and System Elevation <br />o Position of Observation and Vent Pipes <br />o Dimensions & Depths <br />o Mahe, Model, & Number of Chambor Units in Each Cell <br />Fees: <br />o Fire Number & Nearest Road <br />* North Arrow <br />* Contour Lines <br />U Structures & Driveways <br />o Boring Locations <br />* Property Lines <br />o Well Locations <br />o Legal Description <br />-Sanitary Permit Application for Systems Serving Less than 5,000 gal/day <br />$375 <br />-Pion-Plumbing Sanitary Permit and Privy Permit <br />$150 <br />-Sanitary Permit Transfer/Renewal <br />-Reconnection (Section 70.79 Burnett County Code of ordinances) <br />$75 <br />$150 <br />-Revisions <br />$100 <br />-Large Sanitary Systems Serving Equal to or Greater than 5,000 gal/day <br />-installationof Sanitary System without a Permit <br />-Wisconsin Fund Application Processing Fee <br />$500 <br />DOUBLE FEE <br />$100or 10%* <br />-Sanitary Re -Inspection <br />$100 <br />-Soil Test Report Filing Fee <br />$5 <br />