Laserfiche WebLink
NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complet,. All Sections Below This Line = 2. ' <br /> ;T. B <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types I si U. <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION <br /> _i...• F <br /> -.... g <br /> O ivy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> Privy—Vault Toilet (Must specify volume in gallons: 540 (Minimum 200 gal)) g c • <br /> o composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> O Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) 0 <br /> Property Owner's Name: Daniel Chelmo g <br /> f‘ <br /> Property <br /> - <br /> Property Owner's Mailing Address: P.O. Box, 397, Wautoma, WI 54982 <br /> (N) <br /> -,.,..._ <br /> Property Site Address: 7162 South Devils Lake Drive, Webster,41 5489itate zip <br /> rila <br /> Contact's Telephone Number: 920487-4437 < <br /> Contact's Email: daniel.chelmo@centurytelnet <br /> l' <br /> Legal Description of Property: GL4, Ex: N 40 rods, CSM V1 P261, V24 P158 & V24 P270 <br /> Section#: 33 Town#: 40 N Range#: 16 W Town of Oakland m <br /> I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax syslein property page,* 1 <br /> Tax ID#(1-5 digit number;found on tax statement): 33620 <br /> iCl) <br /> --i i <br /> 5= ; <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 5- <br /> '4 "r <br /> 0 !k \)1 <br /> ./A ' 1.7F07. --.., .----7-4c in e.."..c A t<e-ti A A0 1-__ <br /> z IK <br /> ! pz <br /> ---------- ' <br /> Date of staff site visit: Initials of site visit staff: .-------- <br /> Fee Rec:150f:1-3 <br /> r.,.. aut 3013 <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: it-2./a• DATE: 4///7/ 6 <br /> z , <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF < , -.. ----: '--3 <br /> o a <br /> tr, . <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> il 0 <br /> c" .” 0 ..t.... <br /> CI <br /> Page 1 of 2 ;. • c no <br /> Burnett County,Non-Plumbing Sanitary Application --Rev 12/2020 <br /> fit. . <br /> cf, — <br /> i (—c------3) <br />