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a <br />NON -PLUMBING SANITARY PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line = <br />Check Type of Non -Plumbing System/Device; Fee is $150 for All Types <br />A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION <br />otoowt 21;Y� y a <br />a <br />❑ Privy — Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) <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:, <br />Property Owner's Mailin Address: E2 � L_ u , . p �i e + 3 <br />I City State Zip <br />Property Site Address: 9� -f" { <br />Contact's Telephone Number: 7! S _ �,� Z— 20 <br />Contact's Email: t-0 6 � � i `- (A- 01 k r) Pt <br />4 ' J <br />Legal Description of Property: G r±y� , I 8+3 <br />Section #: t 7 Town #:47 <br />' N Range #: W Town of: ? E <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): I `b ! S <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: �'� 1 Initials of site visit staff: <br />PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br />-:�LS -1 <br />Page 1 of 2 <br />Burnett County, Non -Plumbing Sanitary Application — Rev 1/2017 <br />z <br />ro <br />b <br />0 <br />-i Fee Recl,5n.Or <br />x <br />d <br />a® M <br />z� <br />�00 <br />Z <br />m <br />d <br />a <br />ro <br />x <br />m <br />M <br />M <br />