Laserfiche WebLink
BURNETT COUNTY ZONING ADMINISTRATION <br /> 7410 COUNTY ROAD K. #102 <br /> SIREN, WISCONSIN 54872 <br /> 715-349-2138 <br /> NON-PLUMBING SANITARY PERMIT APPLICATION ($50) <br /> POWTS RECONNECTION ($25) <br /> POWTS REVISION ($25) <br /> Application Information—Type or Print <br /> Property Owner Name Property Legal Description <br /> Marcus Zbinden Y <br /> GL NW 1/4 SW 1/4,s 34,T 41N,R 15w <br /> Property Owner's Mailing Address Lot Number Block Number <br /> 6460 Bretton Way 3 <br /> City,State Zip Code Phone Number Subdivision Name or CSM Number <br /> Chanhassen, MN 55317 ( ) CSM V.8 P.40 Map #1535 <br /> Type of Building: (Check one) ❑ State-Owned ❑City Nearest Road <br /> ❑ 1 or 2 Family Dwelling-No.of Bedrooms: ❑village Eagle Lake Rd <br /> ❑ Public X Town of Swiss Fire Number L/d <br /> 29764 Q) <br /> Public Building/Land Use: [Explain the use/purpose for this permit,(i.e., Parcel Tax Number(s) <br /> campground,festival,recreation/entertainment event etc.)] \ <br /> 032-5234-02-400 YJ <br /> a <br /> Type of Permit: Type of Non-Plumbing Device/System/Toilet/Unit: <br /> X Non-Plumbing(Privy,Toilet,Restroom etc.) X Privy—Pit Toilet ❑ Composting Toilet System <br /> ❑ POWTS ReconnectionCounty# ❑ Privy—Vault Toilet(Vault size: ❑ Incinerating Toilet Device <br /> 13 POWTS Repair gallons or cubic yards) ❑ Portable Restroom Unit <br /> ❑ Revision State# ❑ Other <br /> Responsibility Statement: (Check one or both❑as appropriate.) <br /> ❑ 1,the undersigned,assume responsibility for the POWTS activity for which this permit is issued. <br /> ❑I,the undersigned,assume responsibility for the installation of the non- lumbin sanitary system for which this permit is issued. -1 <br /> Plumber's/Owner's Name(print) Plumber's/Owner's Signature: MP/MPRSW No.: Business Phone Number: O <br /> Plumber's Address(Street,City,State,Zip Code): G J <br /> Office Use Only: <br /> // ❑Disapproved Permit Fee: CST No. Date Issued Issut si IT <br /> ,WApproved ❑Owner Given Initial Adverse `D rJ „ �d J fj <br /> Determination L7 / O <br /> Comments: <br /> Conditions of Approval/Reasons for Disapproval: <br /> Revised 6/7/02 <br />