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C a <br /> Cr <br /> @ b <br /> iv <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI a. t.. <br /> Applicant Complete All Sections Below This Line = a <br /> ) <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types C <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION X) i <br /> 34 Privy-Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> ❑ Privy-Vault Toilet(Must specify volume in gallons: (Minimum 200 gal)) o i <br /> r <br /> 0 <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) 9 <br /> T t- t' <br /> Property Owner's Name: SSA 1 uP PER r <br /> r <br /> ,, A.\ <br /> Property Owner's Mailing Address: 1logly ([ ES 7Df1D nn t ,v`GNDOTA� �E1( g, NA 551 I O <br /> p <br /> �] City State Zip <br /> Property Site Address: 73-i O jtMty DE A', LAKE ROAD <br /> Contact's Telephone Number: 661" ZO(a-3ZSZ <br /> Contact's Email: -i-uQ4)G O a @ u1'h11. eau. ii <br /> Legal Description of Property: ( 'OVT. CAT 2 (._lD-'312 'PARCEL 1) B. <br /> b <br /> Section#: O4 Town#: q0 N Range#: /to W Town of: OAKEN D' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q , <br /> Tax ID#(1-5 digit number;found on tax statement): I Z•ei 4 to <br /> VD <br /> 0 <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTE BELOW; ,= " <br /> g?lIP ' C $1 x _e)tlY b e_. 3T--1- ceep Proai 42p orP spl 4cD <br /> lo.,F - 10- y5Ace. I.;mt d-/` is G. b &- i Sot l S►el te.... 6. 6- 9.) <br /> v,I t a e� `� area. ask-e-• <br /> 3 �`l- t� S s -1� W z <br /> r <br /> Date of staff site visit: 00/19.-aD?,3 ke Initials of site vis' staff: A y� Fee Rec: a) <br /> 3 tR1 - ! r Check#:4W <br /> ;I i 2.3 6 <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: Di <br /> r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ....,,�'�J <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r' <br /> gal <br /> Page l of 2 i c4 <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 12/2021 " NI <br /> r <br /> . <br /> �c .) <br />