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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 />O Pnvy — Pit Toilet (Must be accompanied by one soil boring from a WI Certified Soil <br />❑ Privy — Vault Toilet (Mustspecify 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 Mailing Address: <br />Property Site Address: <br />City <br />"I �T'y <br />State Zip <br />Contact's Telephone Number: 7 (5 - [_ZP( �-1D T <br />Contact's Email: if'c�tn�`I(�"' tA)%,. �Ctit��►�"�S��1;J51n��. C C1t*� <br />Legal Description of Property: \z J, j 2 6C PL( j <br />Section #: k ( Town #:__3_7_N Range #:_( ?W Town of: '7-v-cA d4 C_cd:�_ <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): )_311_13 <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: l_ Initials of sA visit st <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: ZO l� <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 />N <br />� w <br />z �) <br />x v- <br />-,ee Re� Sd <br />7cKec K/0 79 7 <br />Ln <br />N <br />C=) "V <br />c <br />ro <br />z <br />� <br />b <br />s' <br />0 <br />OQ <br />0. <br />0 <br />N <br />� w <br />z �) <br />x v- <br />-,ee Re� Sd <br />7cKec K/0 79 7 <br />Ln <br />N <br />C=) "V <br />c <br />