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Date of staff site visit: Initials of site visit st• f: <br /> ,, <br /> ! <br /> , - : a/ <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: moi /� //i ATE. G d.-41 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 2 <br /> Burnett County, Non-Plumbing Sanitary Application—Rev 12/2020 <br /> 07° <br /> S cel <br /> A plot plan drawing is required to be submitted along with this application. The plot plan should be drawn to scale or dimensioned, <br /> and shall be on letter or legal size paper with North being at the top of the page. (Show all items below) <br /> Cl Property lines,road right-of-ways,and road centerlines including distances to property lines,road right-of-ways and road <br /> centerlines for all existing and proposed structures on the parcel. NOTE: *special setbacks for privies are shown in Table 1.This <br /> table is not an all-inclusive list. <br /> O Ordinary High Water Mark(OHWM)and distances to it from the proposed structure <br /> ❑ Floodplain and wetland areas/boundaries and distances to them from the proposed structure <br /> ❑ Existing structures on the parcel including all decks/porches/walkways/etc and including any wells;must show dimensions for ALL <br /> items. Show distance to nearest structure from proposed system. Show distance to all wells. <br /> The proposed structure location must be staked prior to submitting this application to the Land Services Department. <br /> County staff will do an onsite visit to verify site conditions. If the proposed structure(s)are not staked upon County staff <br /> visit,the permit will NOT be issued and it will be returned to the applicant. <br /> *Additional Well Building Lake/Stream Additional County Setbacks <br /> Setbacks <br /> Open Pit 50 Ft 10 Ft 75 Ft 25 Ft to all side lot lines <br /> Sealed Pit 25 Ft 5 Ft 75 Ft 25 Ft to all side lot lines <br /> **OWNER OF SYSTEM AGREES TO THE FOLLOWING BY SIGNING THIS APPLICATION** <br /> 1. No plumbing will be installed in the privy/non-plumbing sanitary system. <br /> 2. No plumbing will be installed on the premises served by the privy unless a code compliant soil absorption system or holding tank <br /> exists,or a valid sanitary permit to install such a system has been issued. <br /> 3. A privy vault/pit shall maintain minimum setbacks as specified in Table 1 and in the Burnett County Code of Ordinances. <br /> 4. Privies for public buildings shall comply with Wis.Adm. Code. <br /> 5. Privies/non-plumbing sanitary systems used for one and two-family purposes shall be vented at least one foot above the roof. <br /> 6. Privy vaults shall be constructed of watertight plastic,fiberglass,or monolithic concrete. Materials shall comply with intent of SPS <br /> 383.20, Wis.Adm. Code. <br />