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r - 2 <br /> a @ IT <br /> 74. <br /> NON-PLUMBING SANITARY PERMIT APPLICATION —Burnett County, WI N <br /> Applicant Complete All Sections Below This Line =0. a �' <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types \ <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION <br /> o <br /> VIPrivy— Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) `� <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) r? <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> 0 Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> Property Owner's Name: ere,i �y Xt.e- 1 <br /> Mailing /T 7 7 ,ce 7'� "pi G /2iV 3�y <br /> PropertyOwner's Address: O) g �� �,- r ,z.•a <br /> -yy City State Zip ('� <br /> Property Site Address: 7 li 3$ L'4 /E j',,.er A/ an d.rr bvr py9/c n <br /> 3 <br /> Contact's Telephone Number: 7<O 3 - 7`% 9/D <br /> )( o <br /> Contact's Email: V.2_ j E : J $ <br /> **If staff has a question about this application,you ill be contacted via email. Make sure your email address is $ <br /> legible and your email provider will accept emails om the following addresses: @BurnettCounty.org and 5' <br /> @BurnettCountyWl.gov crop <br /> Legal Description of Property: 1/,2 SE'Sti/ 1 . <br /> Section#: 21 Town#: LID N Range#: / 7 W Town of: U Al/oil/ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v, <br /> Tax ID#(1-5 digit number; found on tax statement): 2 5 /43 N <br /> —CIw <br /> a x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY on <br /> H o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: h. <br /> z <br /> 1 <br /> .J <br /> yFee Re . 150490 <br /> q Q �n 6 Check#: (c.S A <br /> Date of staff site visit: Initials of site vi 't staff: I a <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE:W)4 aJrri <br /> ��) <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF u, FR <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r 3 <br /> Pagelof2 m43S L <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 12/2022 w <br /> a <br /> K <br /> b <br />