Laserfiche WebLink
2 b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, W1 n ro <br /> Applicant Complete All Sections Below This Line `s <br /> d <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION J--0 O <br /> ❑ Privy—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)) ) t <br /> 9.A Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) '" <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> ` l p r 4Property Owner's Name: c,� 5'%"4 ±S4�tCi„t \ C. (LOt- o <br /> Property Owner's Mailing Address: I •Bc-i/ 4 3 4 S42. IV 0dA-kn es). -c , it <br /> �r^� �_11 City State Zip <br /> Property Site Address: t��-7 --) S. 4. S c' �,:, ,c 6.1..i,PI4SLii.S , U T- 5 i 8 11� C <br /> Contact's Telephone Number: (x25 ) -75 —3 73,4 U o <br /> *Contact's Email: I`� At--; ,�n I-�E ,Z�E�';J �° r,h<, c� .C o,� b U\ 11 <br /> If staff has a question out this application,you will be contact d via email. Make sure your email address is a. <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 3ito' <br /> @BurnettCountyWI.gov b <br /> Legal Description of Property:L T 1 CSM MI I vOL 6 P 16 D3C 4 20 I(P22( bV (,oT 7 <br /> Section#: a S Town#: 3B 0 N Range#: S?,tAO W Town of: Li',exX a:Z o E <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> y <br /> Tax ID#(1-5 digit number; found on tax statement): (38cta is <br /> �• x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY aqV. <br /> ' o d <br /> /�;�Ph THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: w <br /> (WAD lci rey(�irP.wl?,f1�'1 4 IV1S-�tt.Lta+i d✓l �tf Pmpai-i o0 M <br /> Fee Rec:0_ <br /> 'I Check#: <br /> Date of staff site visit: 7/i0I 2 2y Initials of site visit staff' T ,,: <br /> PERMIT APPROVED BY LAND SERVICES OFFICIA : DATE: / 3��Zf U <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFiffu <br /> �� 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .`.3 IvLI �1�-��:��fi <br /> C70 'v <br /> Page 1 of 2 •'. <br /> Burnett County, Non-Plumbing Sanitary Application —Rev 12/2022 E= @'- <br /> s_ Iiir <br /> a <br />