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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 />❑ Privy — Pit Toilet (Must be accompanied by one soil boring from a WI Certified Soil Tester) <br />❑ Privy — Vault Toilet (Mustspecify volume in gallons: <br />(Minimum 200 gal)) <br />XComposting 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: l, lQ UI /l� �i�h� y�➢`Yn i�1,� Z,Zyl ! <br />Property Owner's Mailing Address: /U <br />Property Site Address: ') fct Jt� f�� %(' kep► tCity State Zip <br />z7 <br />Contact's Telephone Number: <br />Contact's Email: Q�dg,z Ao,-3 & pUf�/ ,� 7 <br />Legal Description of Property: �Pr" o1 d/ , --k <br />Section #: 35 Town #:�N Range #: / 6/-rit�l W Town of: ffl e l7 oi? <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): Q. !Y 7 1 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: r✓ A- — Initials of sit visit staff: NA " <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: 7– <br />UPON <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 2 <br />Burnett County, Non -Plumbing Sanitary Application — Rev 3/2018 <br />b z <br />00 <br />CD � <br />W <br />� V <br />i <br />o � C <br />0 <br />M <br />ro <br />as <br />W � <br />L <br />H C7 <br />O <br />Fee ReA� <br />df CK 0 <br />C_ <br />r' <br />M <br />N <br />O <br />co <br />