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9 ro <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI ry 7 i., <br /> Applicant Complete All Sections Below This Line °o a p1 <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types S 9J <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION O <br /> Cd Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> o <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) S <br /> ❑ 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 /> iv <br /> Property Owner's Name: gl VW1--t- Cu lA I'I'Tl/ !-0 3/ <br /> Property Owner'sMailin Address: (50 S ( 111 -701 <br /> SiV-( V 1/1) I e427g, k <br /> Property Site Address: R-k rSSy1 L th cGi v�n�S/ t - 5 'ty' �-�y to Zip,� <br /> Contact's Telephone Number: 1 15-,g4 q - pZ / J�1 1 <br /> Contact's Email: ,tVi.1fO( (a cv t C1 AVl�ll!(nl1 •V1 E. <br /> **If staff has a question about this application,you wil be contacted via email. Make s a your email address is w <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWl.gov 5' <br /> � oo <br /> Legal Description of Property: - J 7 v . <br /> Les f <br /> Section#: `�/ Town#: '-I N Range#: /5 W Town of: SQ,ET)1/1 <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): ci 5 y .. <br /> NI o W i -� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY E. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: u '-' d <br /> M-Fe.+- ail se-1--backS 1. o cal <br /> 2 Privy C142 4i I'1D4- -Itfed ZLl in eS 7 �, <br /> z <br /> x <br /> x <br /> Fee Rec: <br /> m Check#: <br /> —/ti-ifr <br /> Date of staff site visit: `q`'0/2_O Z'( Initials of site visit staff: KT o <br /> cn <br /> rn <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL—rhaya6) DATE: I/ZO/ZIVI , <br /> PI � l J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a = --- <br /> Q co {M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z T rn 0 <br /> Page 1 of 2 2 <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 12/2023 y ro —D- Slit <br />