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a <br /> d � y <br /> NON-PLUMBING SANITARY PERMIT APPLICATION-Burnett County, WI ; <br /> Applicant Complete All Sections Below This Line n 'O <br /> d <br /> Check Tyne of Non-Plumbing System/Device; Fee is $150 for All Types <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION o <br /> f <br /> ❑ Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> c� <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) o <br /> r 5 <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 /> k <br /> Property Owner's Name: ayua f 1 <br /> Property Owner's Mailing Address: 0 ' 15 A ve N� st-.Art+��► MIJ SSA+ i g <br /> City State Zip o0 <br /> Property Site Address: 6.a ke_ R o-a d ,, L v L Vi <br /> Contact's Telephone Number: ( `t — 3 y o <br /> Contact's Email: r e G a off a�G>O . Corn $ <br /> a <br /> Legal Description of Property: L 0 L a-�-e cA, % '1 (o4— <br /> Section#:-a-7 Town#: N Range#: ( g W Town of:Trail e_ Lc3 V-4t_ f° <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): <br /> 0 <br /> F <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1111t120M as swa. d o <br /> i J t <br /> z <br /> �Date of staff site visit: - d J9 Initials of site visit staff: Fee Rec 150,0D <br /> PERMIT APPROVED BY LAND SERVICES OFFICIA TE: <br /> r <br /> a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT O <br /> m <br /> 6. <br /> Page 1 of 2 C <br /> Burnett County, Non-Plumbing Sanitary Application-Rev 1/2019 <br />