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A plot plan drawing is required to be submitted along with this application. The plot plan should be drawn to scale or dimensioned, <br /> and shall be on letter or legal size paper with North being at the top of the page. (Show all items below) <br /> U Property lines,road right-of-ways,and road centerlines including distances to property lines,road right-of-ways and road <br /> centerlines for all existing and proposed structures on the parcel. NOTE: *special setbacks for privies are shown in Table 1. <br /> This table is not an all-inclusive list. <br /> ❑ Ordinary High Water Mark(OHWM)and distances to it from the proposed structure <br /> ❑ Floodplain and wetland areas/boundaries and distances to them from the proposed structure <br /> ❑ Existing structures on the parcel including all decks/porches/walkways/etc and including any wells;must show dimensions for ALL <br /> items. Show distance to nearest structure from proposed system. Show distance to all wells. <br /> The proposed structure location must be staked prior to submitting this application to the Land Services Department. <br /> County staff will do an onsite visit to verify site conditions. If the proposed structure(s)are not staked upon County staff <br /> visit,the permit will NOT be issued and it will be returned to the applicant. <br /> *Additional Well Building Lake/Stream Additional County Setbacks <br /> Setbacks <br /> Open Pit 50 Ft 10 Ft 75 Ft 25 Ft to all side lot lines <br /> Sealed Pit 25 Ft 5 Ft 75 Ft 25 Ft to all side lot lines <br /> **OWNER OF SYSTEM AGREES TO THE FOLLOWING BY SIGNING THIS APPLICATION** <br /> 1. No plumbing will be installed in the privy/non-plumbing sanitary system. <br /> 2. No plumbing will be installed on the premises served by the privy unless a code compliant soil absorption system or holding tank <br /> exists,or a valid sanitary permit to install such a system has been issued. <br /> 3. A privy vault/pit shall maintain minimum setbacks as specified in Table 1 and in the Burnett County Code of Ordinances. <br /> 4. Privies for public buildings shall comply with Wis.Adm. Code. <br /> 5. Privies/non-plumbing sanitary systems used for one and two-family purposes shall be vented at least one foot above the roof. <br /> 6. Privy vaults shall be constructed of watertight plastic,fiberglass,or monolithic concrete. Materials shall comply with intent of SPS <br /> 383.20,Wis.Adm. Code. <br /> 7. SPS 391.12 Privies—requires the storage chamber of a vault privy to conform with SPS 384.25 requirements. The vault shall have <br /> a minimum storage capacity of 200 gallons. <br /> 8. The contents of the pit or vault shall be disposed in accordance with NR 113,Wis. Adm.Code. <br /> 9. This agreement shall be binding on the owner,their heirs and assignees. <br /> THIS APPLICATION CONSTITUTES NOTICE THAT ALL IMPROVEMENTS ARE SUBJECT TO ACCESS AND/OR <br /> REVIEW BY THE LOCAL MUNICPALITY'S TAX ASSESSOR FOR THE PURPOSE OF TAX ASSESSMENT. <br /> I(owner)declare that this application(including any accompanying drawings and plans)has been examined by me and to the best of <br /> my knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application (including any accompanying drawings and plans), and I further declare that I recognize <br /> that this information provided will be relied upon by Burnett County in determining whether to issue a permit. I further accept all <br /> liability that may be a result of Burnett County relying on the information I am providing in this application. I acknowledge that I <br /> will abide by all private/public covenants,restrictions,leases and easements which may apply to this parcel. I agree to permit county <br /> officials charged with administrating county ordinances or other authorized persons to have access to the above-described premises <br /> at any reasonable time for the puurpos. inspectio > <br /> OWNER'S SIGNATURE: 11! / E) <br /> ATE) <br /> SUBMIT COMPLETED APPLICATION,MAPS,PLANS AND FEE TO: <br /> BURNETT COUNTY LAND SERVICES <br /> 7410 COUNTY ROAD K,#120 NO EMAIL OR FAX APPLICATIONS WILL BE ACCEPTED.WE <br /> SIREN,WI 54872 ACCEPT CHECK,MONEY ORDER OR CASH PAYMENT.MAKE <br /> CHECK PAYABLE TO:\BURNETT COUNTY LAND SERVICES. <br /> Page 2 of 2 <br /> Burnett County, Non-Plumbing Sanitary Application —Rev 12/2022 <br />