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<br /> Tr,, be complete and accurate this sanitary permit application must include*
<br /> Property owner's narne and r1.a!iirg address Frcmdr the legal description and parcel tax number(s) of
<br /> where the system is to be installed.
<br /> I! Type of building being served. Check only one and complete # of bedrr,l�ms ;f 1 or 2 Family Dwelling.
<br /> III. Building use. If building type s Pubi4-,. check all appropriate boxes that app'ry.
<br /> IV. Type of permit. Check only ore lure A. Complete line B if permit is fo, tank replacement, reconnection, or
<br /> repair.
<br /> V. Type of system. Check apprrpriate: box depending _m system type.
<br /> J" Absorptior system information; Prov'de all information requested in #1-7.
<br /> `. Ta.rk -nformaf ,n Fill .r; *I-.e rfpac ,; of ever" ew ind' ;1 existing tarn. .-�,t the total gallons. number of
<br /> tanks and ivanufacturer's name Indicate prefeh or site constructed and tank material. Cornplele for a//
<br /> septic., pumph Phe❑ and holding tank-, `.:r ?I- _-star,,. - heck e�;:er approval e,;;, if lainK, receiver,
<br /> experimental product approval from DILHR-
<br /> Vlll_ Responsibility statement. Install!ng plumber is to IF'!! in name, license number with apprapriate prefix (eg.
<br /> tdP, etc: add-ess and oherr -wrr:o r. olumte: must sign appficatlon form_
<br /> iX. County/Department Use Only.
<br /> X County/Department Use Only.
<br /> Complete plans and specifications not smaller than 8'; r " inches nu' be submitted to the county. The
<br /> plans must include 'he fr own, "� nr �1,�1c. r s,+�^ tc a e n x, th -,r_rp;F,g d'r:;ens r. ., iocat on of
<br /> hnldlrg tank(S_ septic to in rd ger i d •.r 1, ura'Is water mains/water s iire,
<br /> streams and lakes, pump or c'rhnn tanks, dist. b,itinr h x s epi! ah .nrpti.^,n systems, replacement systom,
<br /> cas. ar�d the c e g .a ,;i,c r, ' j;Izc n ,.nd ve i ccit slevatior reference points,
<br /> :-) complete specifications for p„mps and controls. nose volume; elevation differences' friction (o-s: pump
<br /> perfcrman,ce curve, pump mode! and pump manufachurer C' cross section of the soil absorption sys'em Ii
<br /> required by the county, E) sort.test data un a 115 form. and F) all sizing !ntormaticn.
<br /> GROUNDWATER SURCHARGE
<br /> 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
<br /> regulated practices which can effect groundwater.
<br /> The monies collected through these surcharg-s airs used for monitoring gror,ndwater, ground-
<br /> water contamination investigations and establishment of standards.
<br /> SBD-8398(R_11/88)
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