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c - z <br /> B b a <br /> NON-PLUMBING SANITARY PERMIT APPLICATION —Burnett County, WI �. N <br /> Applicant Complete All Sections Below This Line ° a <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION ,*o <br /> g <br /> P 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)) `- pd`'S � I <br /> o Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) �4_ <br /> n <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DS S) <br /> _ f v� S- it i _. <br /> Property Owner's Name: PP /n _ • <br /> Property Owner's Mailing Address: v _ / <br /> /��f} Lr-,b c o V� ,&ity/ State Zip <br /> Property Site Address: / tf-� / -1 i r) <br /> 4 <br /> �, f <br /> Contact's Telephone Number: -7rp2 Q`C.-3 l I 99 o <br /> Contact's Email: S <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is 'b <br /> E. <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 'o <br /> ro <br /> oa <br /> Legal Description of Property: PC_L— C 4 <br /> Section#: 7 Town#: 4/ N Range#: /13-- W Town of: v cv/15.5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): R/4c,75 N <br /> -J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a k <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: e d <br /> 1 li\,dlliPYu.W1 riu IS 27 I✓lc1uS 5. s <br /> Loa.-this I s cLL. -cs-6 --} -G locap1U t\ ZSed- on —1-144 co . eFE%lc,.304 7% <br /> WLoci. rvlcl ciA(A sin At&Allot s'P-)4( -k lads by 12 It Z1;21( z <br /> y/I4i e-I- Gil SQ-kIx k S N <br /> y Fee Rec:Me± <br /> 6 Check#: 04:15'rl <br /> Date of staff site visit: 1111 1102 7U Initials of site visit staff:11\-T <br /> v <br /> �/ .i m <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL`!/ f '7 DATE:1°114M r<v -o r_ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a `�- U <br /> c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT i _ -� 0 <br /> friTil <br /> o <br /> Page l of 2 m s a ,. <br /> Burnett County, Non-Plumbing Sanitary Application—Rev 12/2023 ° 5 --0- li n <br /> a CD <br /> r. <br />