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Cl) - <br /> a g. b <br /> NON-PIrJMBING SANITARY PERMIT APPLICATION -Burnett County, WI F N <br /> Applicant Complete All Sections Below This Line z a N <br /> d <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types V <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION <br /> i <br /> ❑ Privy-Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) _ ^ c. <br /> F <br /> Privy-Vault Toilet (Must specify volume in gallons: 5 00 (Minimum 200 gal)) <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> Property Owner's Name: 0(-\ <br /> Proper Owner's MailingAddress: \( 1 A.R. '�c'i 1 Anokv, m 'SS 303 <br /> 70M vi 1 R'1 "DI- City State Zip <br /> Property Site Address: LcA- Lk —.S((Us Pine_ "Tr � (,(,,Z:tinc!-, t� <br /> Contact's Telephone Number: —I(s� S 562 1 0 V) <br /> -n <br /> Contact's Email: 30f-L . ( ROS`7-s1 e (.yY 1 L . t�ot'1 $ <br /> Legal Description of Property: LOT t{ C So 5 160 UOL Z9 P 2_0_' E. <br /> ao <br /> Section#:3 3 Town#: (53A)N Range#: I (0 W Town of: 1 "M e tr(),-' .,,,, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <---". <br /> Tax ID#(1-5 digit number; found on tax statement): LU! ap1.5n <br /> -i <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY L 3 <br /> THIS PERMI IS UBJECT TO LL CONDITIONS LISTED BELOW: x <br /> e <br /> ,k ee.4- AA se al <1«A1 A.ti ,1-..k rte .'eroleitis 4.u 04 <br /> r) z h N <br /> -i, p:, , <br /> 6---- <br /> � <br /> Date of staff site visit:9 1 V 1 12-42- Initials of site visit staff: Fee Rec: i , ( - <br /> ,/ Check#: C4 � <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: # 7 DATE: `//1)9'2 d <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT y.•. co t ' 0 <br /> 19 C <br /> Pagelof2 NJ <br /> Burnett County,Non-Plumbing Sanitary Application-Rev 12/2021 <br /> b <br />