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z <br /> cr 9 b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI <br /> N <br /> Applicant Complete All Sections Below This Line = i' <br /> 0 <br /> Check Type of Non-Plumbing System/Device; Fee is$150 for All Types <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION O <br /> i <br /> 0 Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) . <br /> pi Privy—Vault Toilet(Must specify volume in gallons: Sri/00 (Minimum 200 gal)) r <br /> 2. r <br /> 0 Composting Toilet System(Must demonstrate unit is approved for use by WI DSPS) 4 <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> Property Owner's Name: 5u.. Af$ CFpc QN� ^� ,. - �� <br /> Property Owner's Mailing Address:,�j�R c/Q S Th-f e R d /el U/c bs i e r- �/ 2 5c1 3 1, <br /> City State Zip 1 <br /> Property Site Address: .CC/ ' <br /> Contact's Telephone Number: 715- 79/ • Li , z C <br /> 0 <br /> Contact's Email: C i /r4.4 7T1 W-o Al G , I, CO/A d <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is E <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWl.gov g' <br /> Legal Description of Property: PC.L IA/ t' ,te 1 L/ o0 <br /> Section#:3 6 Town#: 57 N Range#: /6 W Town of: N/ee#0,/ '-N <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): /41 5 6k '0i <br /> o .� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <br /> . 14-. g.,i <br /> W z <br /> z <br /> 6' <br /> x /� <br /> Fee Rec: [, V� <br /> 5 Check#:_e /l <br /> Date of staff site visit: (1/16 ALI Initials of site visit staff: [ i- 14-r <br /> a <br /> PERMIT APPROVED BY LAND SERVICES OFFICIA r) DATE:701�i*x! < _ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF r l J� <br /> Nt <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Fr?WY 0 <br /> i C- inni <br /> n N n c_r, <br /> Pagelof2 < og e.,, 7 <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 12/2023 ° t imi <br /> II {{ ' I <br /> J <br />