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_ - <br /> a R b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI : N N <br /> Applicant Complete All Sections Below This Line 0 <br /> o a <br /> \ r7 <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION o <br /> Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) • • <br /> r <br /> 0 <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) ..•► <br /> li <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> • <br /> Property Owner's Name: �b v6 L A -4\--C A,Q-y tJ en\/i,.-J i' <br /> Property Owner's Mailing Address: /0(( - y(5 r( )f QE;-(I Ccv:Nne.k Et6�k"SMN 55421 N r <br /> IP <br /> /' City State Zip <br /> Property Site Address: Z �'�((p t CJ �CS cS e_a. c) <br /> I <br /> Contact's Telephone Number: 1 I 5 27r-C S 5-3 <br /> Contact's Email: Kcc-i"`y v\/ \\O v' it O elka t ( b C l O► o N 1.114 <br /> **If staff has a question about this application,you wi'1 be contacted via email. Make sure your email address is Vi • <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov g' ', <br /> cm <br /> Legal Description of Property: rt' Z, C5 PA w LA "3`\ v z 5l P 3 ( (�u�1 5 e-' <br /> Section#: "2>3 Town#: .C1 N Range#: (q W Town of: (Nisi c.!1 N 4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> ) <br /> Tax ID#(1-5 digit number;found on tax statement): �j 3R z-A o <br /> N <br /> UJ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d y <br /> CD t lgttN DEert4 Harr To e--,tcee-T> 31" k. w <br /> @J 24 OF Fit_L. -ra BE ?(AcEO OVER. PRtVY L..0 co,Tie") W <br /> ® C kuat,J ge-au 4 k15NTS OF PRIM( MISTA1J Tto'v Rerkevoue'VT z � "ND <br /> = <br /> ,o <br /> b <br /> EA Fee Rec:Jr <br /> v Check#: 036 <br /> Date of staff site visit:$!2`s!` Initials of site visit staffs z <br /> v <br /> w <br /> tr <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: t----\--- I DATE: /c/Z/Z°Zr g <br /> {� — <br /> UPON APPROVAL: APPLICAN US POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z (� <br /> Page l of 2 i .8 c4 <br /> 1 <br /> g m (� <br /> Burnett County, Non-Plumbing Sanitary Application—Rev 11/2024 <br /> -2) <br /> i <br />