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0 b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI 7,; u N <br /> Applicant Complete All Sections Below This Line 7 n '� <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types .-.56 <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION o <br /> ❑ Privy— Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) y� <br /> I Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) -� o N <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> kt <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> Property Owner's Name: 46,14 I �t' /e'/z) 9. -.4\ <br /> Property Owner's Mailing Address: 7/2)2g T-413 e P. LqK, D R, (74 i((g u ey itlE 6'`f g 74 <br /> City State Zip <br /> Property Site Address: 3/c 2 6 f4 0 0 Z L /<'G DR, n it_A1-6 u toy S 4 r3 6 y <br /> 4 <br /> Contact's Telephone Number: 7( - ? e.17- 2 C 3 4( o <br /> Contact's Email: c} S 57 lle L/ 7 0 ,to fl t• (1.7e/ , <br /> I <br /> Legal Description of Property: 4 6 1 2 C 5 Al V 7P /03 CIN (;p i/ L o r j) 5' <br /> b <br /> Section#:5//7 Town#: hit N Range#: (5.-- W Town of: Cal J(S S c. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* \ <br /> Tax ID#(1-5 digit number;found on tax statement): 2/3 g,6` <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY - <br /> co <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> _0. <br /> d <br /> G1 <br /> 1 <br /> Date of staff site visit: 5 3' 2'l Initials of site visit staff: lJ• • -i Fee Rec: 155"' <br /> ` C-wir 1217 <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: / TE: •, l"-2-) o <br /> mir- <br /> > <br /> v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF < `� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a .w <br /> fn <br /> L7 O _� <br /> r- = <br /> Page 1 of 2 ri <br /> Burnett County, Non-Plumbing Sanitary Application—Rev 12/2020 rail s ,. / <br /> m <br /> 0 <br /> K <br />