Laserfiche WebLink
vD ro z <br /> 0. 2 b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION —Burnett County, WI R: 7,. ;ti <br /> Applicant Complete All Sections Below This Line ° a ~ <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types d ON <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION O <br /> Og <br /> XPrivy— Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) .-c., ' ' -o <br /> ❑ Privy-Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) oV N - <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) l., j <br /> N <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> O <br /> Property Owner's Name: Ke,14 Q Nd Cay f ( k[7Y i sexi `( iv ;jy -feu 1 S i N <br /> Property Owner's Mailin Address: I 1 633 PQ(meii Road d 1)(00VMiNQ M N 55(137 �j <br /> City ,./ 'tate Zip <br /> n <br /> Property Site Address: r $O3 o�[� S��� n <br /> Contact's Telephone Number: Pa, ((1z3) --734- 4 5$(p o <br /> -11 <br /> Contact's Email: Pa-t-17 <br /> Q \! ��1 OlM 5 eq-) la' I C-1U Ltd CO inn a- <br /> . <br /> Legal Description of Property: / PLC Gov L OT 2 1 <br /> ro <br /> Section#: I I Town#: 140 N Range#: I y W Town of: SC 0±t ao <br /> *Attach additional page if needed for lengthy description OR attach a copy <br /> of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 17103 <br /> c <br /> -3 <br /> ... o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: y <br /> �oom n'C P;* pc'.v V.rn.1(e� 'Iro 31" belov,1 count. d �' <br /> g F). s a <br /> So (- u Le-. = o -t- �y <br /> SA <br /> z o <br /> PoW <br /> lv <br /> f P <br /> Date of staff site visit: \0/ Li / Z.1 Initials of site visit staff: r'1 S Fee Rec: <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: Kal!,�/Uyv Y QPDATE: i41/it 'o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a ,„ R1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <33 73 <br /> n'��� <br /> y ..Y wY <br /> 7 <br /> � <br /> Page 1 of 2 -3 • <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 12/2020 r , <br /> a <br /> 3 <br /> z <br />