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cn -0 z z <br /> a '',-0NON-PLUMBING SANITARY PERMIT APPLICATION — Burnett County, WI y i,, <br /> Applicant Complete All Sections Below This Line = a `I <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types d <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION O <br /> 54 <br /> X Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> n t7 <br /> o <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) .- * <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> r <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> ?--. <br /> Property Owner's Name: S((}tt Ha,use r <br /> I. <br /> Property Owner's Mailing Address: -icig 3" Atte S Or pi heap 1t 5PM/ j j t i f Cityd <br /> ��J State Zip <br /> Property Site Address: 399�/ /i1(nerva ChVvt kU D�(j;A J 1n,S�. ,Sip 30 n <br /> Contact's Telephone Number: Lf/i.1 - 1/o 7`6�, .'3 P <br /> Contact's Email: S M14;ill F S MO i l'CCM <br /> **If staff has a question about this applicati ,you will be contacted via email. Make sure your email address is ,� <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = <br /> @BurnettCountyWl.gov <br /> Legal Description of Property: \NI AUt‘j E)( a 3 }3 <br /> Section#: 3 c, Town#: Li ( N Range#: l 6 W Town of: 5\ii i S`i <br /> A <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* E - -3 <br /> Tax ID#(1-5 digit number;found on tax statement): A 39 N� (J�1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYtm e o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 4. _C CA N <br /> Mee4 RII sed.blcits { 54.4ers w <br /> No Ocotb;ii s s.1/o C s,hW mos+ 6e ri4i) z <br /> N N . <br /> Fee Rec: t 57 — <br /> Q = Check#: 1 -7 ) <br /> Date of staff site visit: 6 f d 1 0---3 r Initials of site visit staff: y <br /> 6 ` L._J <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE/iZ 2 < j rr <br /> rz <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo u uou <br /> -c ' ® C <br /> Page 1 of 2 1 �� w <br /> Burnett County, Non-Plumbing Sanitary Application—Rev 12/2022 < sfiiril <br /> e — <br /> i <br />