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a z <br /> Cr <br /> a `d <br /> NON-PLUMBING SANITARY PERMIT APPLICATION — Burnett County, WI �: 1, <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 /> ❑ Privy— Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) Rt <br /> o d <br /> Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) <br /> o <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 /> Property Owner's Name: 04/10 t2-1411)k <br /> Property Owner's Mailing Address: — % /v S <br /> City State Zip <br /> Property Site Address: 6 1/5/ A&ZO Z'/l�� I�n� <br /> Contact's Telephone Number: �, 1�116 3 OL � <br /> 0 <br /> Contact's Email: �/(��// �KT ,COm °o <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> w <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 5 <br /> b <br /> Legal Description of Property: 51=?t S j ) (� <br /> Section#: 33 Town#: N Range#:_/2_W Town of:bj) ST AAS& <br /> *Attach additional page if needed for lengthy description OR attach a1 copy of the deed OR attach tax system property page,* <br /> Tax ID#(1-5 digit number; found on tax statement): O oC 3 o <br /> W F <br /> o W ° •� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o C d <br /> FO L"w PKtV 9 IN5 rA LLA-r1 cW .4 G 6ECVAGy7' 3t QD <br /> z N <br /> W \JQ <br /> z <br /> y Fee Rec:�� <br /> v Check#: 3b <br /> Date of staff site visit: 71(11 Z3 Initials of site visit staff:M o <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: l DATE: 2aZ5- �® <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF M <br /> XF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT rj <br /> a a o <br /> Page 1 of 2 sNr� <br /> Burnett County, Non-Plumbing Sanitary Application-Rev 11/2024 <br />