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z <br /> NON-PLUMBING SANITARY PERMIT APPLICATION-Burnett County, WI y: y N <br /> Applicant Complete All Sections Below This Line 7 a I <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types W <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION �,..D O <br /> Gd'Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> 1 <br /> o <br /> r <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) <br /> j <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) f. <br /> O Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) C% <br /> Property Owner's Name: /(ice// Col4k1 6v-e S! <br /> Property Owner's Mailing Address:1{5t S+a `70, S%Yml vi Ve l 54 7g r <br /> Property Site Address: NoV-E' Labt' rGkot , - 0���0W Ci� Sja;e , Z� 2 \ <br /> Contact's Telephone Number: i 15-34 q " oq/57 <br /> L <br /> Contact's Email: S MSG?V .+0((cif lt,C/4 !mil pt/n bA rV1<{ A V((i./W I' eV E. f <br /> **If staff has a question about this application,you will be contacted via email. Make sur' your email address is Il- <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 5' <br /> ro Legal Description of Property: (� . �1 '`tJ � <br /> Section#: ,3/ Town#: LID N Range#: /5 W Town of: I7GC l-a vl <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): q <br /> N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a• <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v y <br /> Mk+ CLu St-A4CiS v. <br /> 2 P6v.-1 riQ.t9-1-i , ncrl -4o 4X(Pbd 34i inrieS S -C <br /> z <br /> m <br /> 73 Fee Rec: <br /> o Check#: <br /> mi <br /> Date of staff site visit:47/1D lZall Initials of site visit staffs o <br /> PERMIT APPROVED BY LAND SERVICES OFFICIA : DATE:9/20R !ii,,, <br /> _ r�UPON APPROVAL: APPLICANT MUST POST COPY OFW �1t11SIGNED PERMIT APPLICATION IN PLAIN SIGHT a c` 'C� <br /> n <br /> Page 1 of 2 < 12-- N <br /> Burnett County,Non-Plumbing Sanitary Application-Rev 12/2023 ° Fi, liii <br /> i <br />