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.. <br /> a <br /> a 0 b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION —Burnett County, WI -: ' Sly. <br /> 5. iii <br /> Applicant Complete All Sections Below This Line a '`C <br /> r7 <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types Fi <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION \ o <br /> i <br /> ❑ Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> X. Privy—Vault Toilet (Must specify volume in gallonsj-45-0-6EO(Minimum 200 gal)) r <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) o <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> a <br /> Property Owner's Name: ��x\\v ki`'‘ LCD CV-2-- '- <br /> - <br /> Property Owner's Mailing Address: S(DLitS —[13 SA' . 0 c r Ai, Bran 3.V, MO S`SOS P , <br /> ,City _ State Zip <br /> Property Site Address(P Li k Ca CAS\y h e-s't�k cp c,a L D e- st-tj', W .1r S-4 IS l 3 n V <br /> Contact's Telephone Number: (QS 1 4o$ 1 cl(o ° <br /> Contact's Email: 60 (.�e- SI04 S& t Gl o r) , CA)1M\ ° <br /> 0 <br /> Legal Description of Property: L5. <br /> 'I <br /> Section#: Town#: 1'3 9 N Range#: R 1`1 W Town of: �v 3 <<- rill.' ro°o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> Tax ID#(1-5 digit number;found on tax statement): 3(.0(.Q 2-30 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N "q w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d ,-3P d <br /> cn <br /> Date of staff site visit: )l / i0V-1 Initials of site visit staff: (.9.414,"C ca <br /> Fee Rec: t�— <br /> yC( (a.73 <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL&4% DATE: /'I5)24/ 8 <br /> r <br /> i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF tz <br /> l <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT y = <br /> c c..- <br /> ffi <br /> `°k `.-,- 0 <br /> 2 _ <br /> Page l of 2 M o o --., o <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 12/2020 w S c4 <br /> m111/1) <br /> J <br />