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z <br /> � b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION-Burnett County, WI b <br /> Applicant Complete All Sections Below This Line a <br /> Check Type of Non-Plumbing System/Device. Fee is $150 for All Types r <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION <br /> 0 <br /> V � <br /> R <br /> ❑ Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) �o <br /> I Privy— Vault Toilet (Mustspecify volume in gallons: 3o0 (Minimum 200 gal)) i =° <br /> o <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) ?-- <br /> W <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) v <br /> a <br /> , b <br /> C, ►- <br /> Property Owner's Name: <br /> Property Owner's Mailin Address: A t r I v <br /> City 5tate Zip <br /> Property Site Address: <br /> t <br /> �p� l- �D � 75�� _ <br /> Contact's Telephone Number. � y <br /> H C5� a <br /> Contact's Email: � <br /> @/� rl7 �k..�oa nGa <br /> Legal Description of Property: `o f / e 5lV (/y. T 17L (Gov L o4 3) <br /> CN <br /> Section Town#:_3 _N Range#: 19 y�vy Town of: —rAc v, L�_ o ` y� <br /> *Attnch additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> d � <br /> N <br /> Tax ID#(1-5 digit number;found on tax statement): 3777 g W <br /> L� <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY ' <br /> THIS PERMIT IS SU JE T TO ALL CONDITIONS LISTED BELOW. ` <br /> e e L of '4 L av .�� <br /> w A � <br /> a v 6-7 .v Id r- Ari v o ffe bt,609aZ o ✓1'Ja r v <br /> � o <br /> � z <br /> N <br /> N Q <br /> Fee Rec: <br /> d <br /> Date of staff site visit: 7- 19- 17 ln' ials f site visit aff: -OXN <br /> 0 0 <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE:7 /9-17 <br /> > C ` M <br /> Z C <br /> � Nm <br /> Z <br /> A z � CAPX11 <br /> m Z O IV m <br /> Page 1 of 2 0 �j C C= p< <br /> Burnett County,Non-Plumbing Sanitary Application —Rev 1/2017 > 6�� <br /> b <br /> x <br /> `a <br /> M <br />