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a `d <br /> 5' !b <br /> N N <br /> NON-PLUMBING SANITARY PERMIT APPLICATION —Burnett County, WI a. <br /> Applicant Complete All Sections Below This Line d <br /> n <br /> O <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types RT <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION <br /> P l' <br /> X Privy —Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil o 1.) <br /> Tester) <br /> V <br /> ❑ Privy —Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) ...NJ. <br /> 0 Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> o D <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> Property Owner's Name: Patrick and Cindy Henderson ta, <br /> p <br /> o le <br /> Property Owner's Mailing Address: 417 Whiskey Road SW Isanti MN 55040 1 <br /> City State Zip F. <br /> Property Site Address: ..e2925- �/ 'T %Cl/2J ��.,6_,,/ 1,vr ,5Y3 <br /> ' II <br /> Contact's Telephone Number: 763-222-6191 _ <br /> 00 <br /> Contact's Email: henderson6966Ayahoo.com <br /> Legal Description of Property: lot 1 CSM 4477 V24P251 <br /> Section#: 35 Town#: 41 N Range#: 16 W Town of: Swiss o i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* s• x <br /> cm <br /> .--i <br /> d <br /> 335g C d <br /> Tax ID#(1-5 digit number;found on tax statement): �' <br /> W <br /> -=. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY THIS z <br /> PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - Fee Rec: 50 <br /> 412e <br /> 0 <br /> PV o t_ Uuu <br /> 'Acg) c 0 <br /> m F. <br /> 'Lit') <br /> Z 1 <br /> rn <br /> NI <br /> rti <br /> LTJ <br /> b <br />