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z <br /> NON-PLUMBING SANITARY PERMIT APPLICATION - Burnett County. WI <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 /> F <br /> 7 <br /> Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> n <br /> ❑ Privy—Vault Toilet (Must sipeci volume in gallons: (Minimum 200 gal)) <br /> 0 <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) —tom <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> -o <br /> p rty <br /> Pro e Owner's Name: Q� �r!til S e z <br /> Property Owner's Mailing Address: 0Gt � C O✓✓"' !2;— <br /> /� City State Zip <br /> Property Site Address:Lof /5-- •J1.>!� OeLkl4 n d_ •Sh,)�S <br /> 6A4_16L1tid, Gvc,v s•l-e d Q <br /> Contact's Telephone Number:�� _�/mob <br /> Contact's Email: C( Sei1 2� q W�G� t C 6 ✓y► p <br /> Legal Description of Property: 4,0 /S 31-ek SAU/Ys <br /> ao <br /> Section#: Town#: N Range#: W Town of: Jcz�ald c <br /> *Attach additional page if needed for lengthy description OR attach a cant'gfthe deed OR attach tax si,stem property page.* <br /> Tax ID#(l-5 digit number;found on tax statement): <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS-ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONSEL : <br /> W <br /> /� ST BET: <br /> �"r;vH �e,06�.� T Ale /�Ays .. . <br /> r <br /> z <br /> Fee Rec: s(,roo <br /> Date of staff site visit: Ini tals of si a v' t staff: N <br /> °z <br /> z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: 7-3— /7 <br /> T <br /> Z <br /> 40 <br /> , � <br /> �o <br /> Page 1 of 2 o <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 1/2017 <br /> s <br /> m <br /> a <br /> m <br />