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. <br /> • CT0 b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION — Burnett County, WI v i., <br /> Applicant Complete All Sections Below This Line 0 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 rt. o <br /> 1 F <br /> i Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) N <br /> 0 <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) o - <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) .� ;41 <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> ' A o , <br /> Property Owner's Name: ,"�,t C-(-t11- L AN-N) 1-44 V f /U L-(ti LX L t4 L L II s t,) <br /> ,� � <br /> Property Owner's Mailing Address: Z�b(os STATE !'mil,- \ j DffW8Ut t, 1 <br /> Q City S ate Zip <br /> Property Site Address: V t C1 O C I L B �1 u.)e-e ---k------2 t „ut( t4-.63,0 n <br /> Contact's Telephone Number: .ls S 7 - 'ADZ Z C <br /> 0 <br /> -n <br /> Contact's Email: i. M J"1 Wit,C..,,,j0,1%,U,("VPC..e.X1 `-U V 1 r\1&,X'& u 1% <br /> ca.**If staff has a question about this application,you will be contacted via emai Make sure your email address is M. 0 <br /> ' <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov k <br /> b <br /> Legal Description of Property: fR 6\t‘1 Svc E`.QS I\I.V O I25 <br /> go <br /> tJ <br /> Section#: t\ Town#: 3c-1 N Range#: V(0 W Town of: i INn‘•.) LP <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): Z(cs q(, (9 <br /> N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 5' x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d -- d <br /> 1 mUsi- rn.ez4 ua Se -s b. -� <br /> cj <br /> 2 De.ellik 4 priv'( (tin no-1- 4)c cl Z ►rL-e& aue -1-0 SPi l ConL'+t s(1s 7c) z 5 S <br /> 6' <br /> Fee Rec: 00 <br /> o Check#:S 510. <br /> tr <br /> 4 115'zozq Initials of site visit staff: T +V r iL r <br /> Date of staff site visit: d <br /> VD <br /> PERMIT APPROVED BY LAND SERVICES OFFICIA —Th DATE:41/ �Zy n . JJ <br /> m r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a Q nIna <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT cocn rn <br /> z 2 <br /> m CD C ma <br /> Page 1 of 2 < co <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 12/2023 <br /> L� J <br /> 4 <br />