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z <br /> tv <br /> NON-PLUMBING SANITARY PERMIT APPLICATION —Burnett County WI ;ti <br /> Applicant Complete All Sections Below This Line y n ;a <br /> o. <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types .E3 <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION �� O <br /> 111%. to <br /> rivy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) a <br /> n <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) -- • <br /> 0 <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> s <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) ; <br /> Property Owner's Name: \C\'"k c1-`b P I- (''`t 0?� f�) g <br /> Property Owner's Mailing Address: l v f o-'b u v IP Otic 4-0 J <br /> City State Zip c:5-4 3 <br /> Property Site Address: . -c7 ez_ t-a"t9!^' c i���l �i�• n <br /> _CV 3 ke o <br /> Contact's Telephone Number: ( 2.,�E( g <br /> Contact's Email: PA c�I i 1-- /r-t<(LG ( �r^ <br /> 4.F'rt cfZ t CD S <br /> **If staff has a question about this application, you will be contacted via email. Make sure your email address is 'd <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and %2' <br /> @BurnettCountyWl.gov oa <br /> Legal Description of Property:A. /Z-5& L'f/'`,y f L s(e 0 L 1 OF L.0/49 ',Ake <br /> a. <br /> Section#: 05- Town#: (-jb N Range#: / 7 W Town of: Sc 0T'7— <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c, <br /> 0 <br /> Tax ID#(1-5 digit number: found on tax statement): ( 7 '7 ( ' N i <br /> A <br /> y x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 3. __ t J <br /> ?"/" /hw5 f be aftea..sa- 2C:, ;noes Secp 0 —J <br /> z <br /> z <br /> -C <br /> 6, Fee #:_ <br /> - 6 Check <br /> #: <br /> Date of staff site visit: ( f2Lf/Z0Z3 Initials of site visit staff: /7- y <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL - DATE: //11/23 '73 w In�,� <br /> Uut) <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF f g 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g 2 �, <br /> :, o <br /> F3 <br /> Page l of 2 'A 3 <br /> irril <br /> Burnett County, Non-Plumbing Sanitary Application —Rev 12/2022 a p I ' <br /> i <br /> ro <br />