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A plot plan drawing is required to be submitted along with this application. The plot plan should be drawn to scale or dimensioned, <br />and shall be on letter or legal size paper with North being at the top of the page. (Show all items below) <br />❑ Property lines, road right-of-ways, and road centerlines including distances to property lines, road right-of-ways and road <br />centerlines for all existing and proposed structures on the parcel. NOTE: *special setbacks for privies are shown in Table 1. <br />This table is not an all-inclusive list. <br />❑ Ordinary High Water Mark (OHWM) and distances to it from the proposed structure <br />❑ Floodplain and wetland areas/boundaries and distances to them from the proposed structure <br />❑ Existing structures on the parcel including all decks/porches/walkways/etc and including any wells; must show dimensions for ALL <br />items. Show distance to nearest structure from proposed system. Show distance to all wells. <br />The proposed structure location must be staked prior to submitting this application to the Land Services Department. <br />County staff will do an onsite visit to verify site conditions. If the proposed structure(s) are not staked upon County staff <br />visit, the permit will NOT be issued and it will be returned to the applicant. <br />*Additional <br />Setbacks <br />Well <br />Building <br />Lake/Stream <br />Additional County Setbacks <br />Open Pit <br />50 Ft <br />10 Ft <br />75 Ft <br />25 Ft to all side lot lines <br />Sealed Pit <br />25 Ft -- <br />-S Ft <br />75 Ft <br />25 Ft to all side lot lines <br />**OWNER OF SYSTEM AGREES TO THE FOLLOWING BY SIGNING THIS APPLICATION** <br />1. No plumbing will be installed in the privy/non-plumbing sanitary system. <br />2. No plumbing will be installed on the premises served by the privy unless a code compliant soil absorption system or holding tank <br />exists, or a valid sanitary permit to install such a system has been issued. <br />3. A privy vault/pit shall maintain minimum setbacks as specified in Table 1 and in the Burnett County Code of Ordinances. <br />4. Privies for public buildings shall comply with Wis. Adm. Code. <br />5. Privies/non-plumbing sanitary systems used for one and two-family purposes shall be vented at least one foot above the roof. <br />6. Privy vaults shall be constructed of watertight plastic, fiberglass, or monolithic concrete. Materials shall comply with intent of SPS <br />383.20, Wis. Adm. Code. <br />7. SPS 391.12 Privies — requires the storage chamber of a vault privy to conform with SPS 384.25 requirements. The vault shall have <br />a minimum storage capacity of 200 gallons. <br />8. The contents of the pit or vault shall be disposed in accordance with NR 113, Wis. Adm. Code. <br />9. This agreement shall be binding on the owner, their heirs and assignees. <br />THIS APPLICATION CONSTITUTES NOTICE THAT ALL IMPROVEMENTS ARE SUBJECT TO ACCESS AND/OR <br />REVIEW BY THE LOCAL MUNICPALITY'S TAX ASSESSOR FOR THE PURPOSE OF TAX ASSESSMENT. <br />I (owner) declare that this application (including any accompanying drawings and plans) has been examined by me and to the best of <br />my knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br />information contained in this application (including any accompanying drawings and plans), and 1 further declare that I recognize <br />that this information provided will be relied upon by Burnett County in determining whether to issue a permit. I further accept all <br />liability that may be a result of Burnett County relying on the information I am providing in this application. 1 acknowledge that I <br />will abide by all private/public covenants, restrictions, leases and easements which may apply to this parcel. I agree to permit county <br />officials charged with administrating county ordinances or other authorized persons to have access to the above -described premises <br />at anv reasonable time for the Duroose of inspection. .. <br />OWNER'S SIGNATURE <br />(DATE) <br />SUBMIT COMPLETED APPLICATION, MAPS, PLANS AND FEE TO: <br />NO EMAIL OR FAX APPLICATIONS WILL BE ACCEPTED. WE <br />BURNETT COUNTY LAND SERVICES ACCEPT CHECK, MONEY ORDER OR CASH PAYMENT. MAKE <br />7410 COUNTY ROAD K, #120 CHECK PAYABLE TO: BURNETT COUNTY LAND SERVICES. <br />SIREN, WI 54872 <br />Page 2 of 2 <br />Burnett County, Non -Plumbing Sanitary Application — Rev 1/2019 <br />