Laserfiche WebLink
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 />0 Privy —Pit Toilet (Must be accompanied by one soil boring from a WI Certified Soil Test <br />A Privy —Vault Toilet (Mustspecify volume in gallons: 330 (Minimum 200 gal)) <br />0 Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br />0 Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br />Property Owner's <br />Property Owner's Mailing Address: <br />Property Site <br />LIN <br />Contact's Telephone Number: ��\ a --yl --I 34 o� <br />Contact's Email: \J L.&t_ J 6 (5�1_ �/c& I c_c vv--� <br />City <br />Zip <br />Legal Description of Property: /-A <br />Section #: Q-5 Town #: -3 9 N Range #: W Town of: _vv_(.)yN <br />*Attach additional page if needed for lengthy description OR attach a coop/y of the deed OR attach tax system propertypage.* <br />Tax ID # (1-5 digit number; found on tax statement): 3 oQ 7 7 O <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: ,� - d L ") e Initials of si isit staff- DZ <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <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 />[c <br />V <br />0— <br />r - <br />OR r- <br />0 <br />Q <br />CD <br />Z <br />0 <br />F <br />0 <br />z <br />It <br />b <br />ao <br />FAI <br />a <br />_1� AFee 'ec: <br />Cke,-l a 35 <br />I <br />MME <br />N R <br />