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JUN-18-2005 03 :08 AM P. 01 <br /> ._.__W.._. PacE ®1 <br /> 06/17/2905 13:58 3452166 8 C ZONING <br /> BURNETT COUNTY ZONING ADMINISTRATION <br /> 7410 COUNTY ROAD Kr#102 <br /> SIREN, WISCONSIN 54872 <br /> 715-349.2138 <br /> NON-PLUMBING SANITARY PERMIT APPLICATION(S50) <br /> POWTS RECONNECTION(SM <br /> POWTS REVISION(S25) <br /> Application tetbrsoebn—Type or trine <br /> Properq��� t.e�t Description <br /> i SPt7T VAN,it/Sw 0 <br /> TropeRy ars M Ibrg Andres Mu Block Number <br /> -eke t�iT <br /> city.irate pipcods NM *Islan Nam 4 C3M Nusebor <br /> ., i JILL '041 <br /> bye of Dondin�: Cboeh ono)4 stiswoMmed d CCitlygt Semis S � 0#0 i or 2 Family Dwo)tit►;-No Of Rcdroatm:,4 TFnNMbW <br /> d Priblk '�p'� <br /> Prblle BYikll■g/I.nt�d UIu: (thcplaln rhe uapyarpoae Ibr this eaonit(i,e., Paruei Tut Numbers) <br /> wopwoued,tlrtfveL re miss s0awdkeemt event 010) o3 a-Ola o-oa�o d <br /> /fLcrG9 4M r7. <br /> Rpir of Permltt Type of Non.Pktmbtng Device/Systemllbll nit: <br /> Non-Plumbing(Pri+y,To*Rao" m do) j1t Privy-Pit Toilet 0 Compoering Toils System <br /> po"Reconnection Privy-Vault Toilet(Vann eine: ©•Incitooreting Toilet Device <br /> G POWTS Repair COY^ R gellaas or cubic yards) © Portable Reetrootn Unit <br /> is Revision Stele M mother <br /> IResptmelbtgty 9ltainmeinll (Check ane or hottl 0 m eppte ift.) <br /> Q L Yre undersigned,mum responeibilby for the POWTS odivily which this permit it issued. <br /> the undoralsooL eeeu■ra resconallbillby for the buitalloslon Of um serilbr which this t is issued, <br /> aNmM(print) t esu MPIM 5 Noue,: rrts FROM Number: <br /> Plw>bero Aa rm(Ilinst,City.Stift Zip Coit) <br /> Iamo@ Use onlyt <br /> O Pee: CIT Ne. Dau ser Pg Agog urn <br /> C�Approved <br /> no tlhren InIW Advnee <br /> petereritletlon <br /> Commena: <br /> CoYamon,of Aparov■l Ale■sems for Drnpprevah <br />