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cr <br /> NON-PLUMBING SANITARY PERMIT APPLICATION - Burnett County, WI s �° <br /> N <br /> Applicant Complete All Sections Below This Line ry ©1 <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types d <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION <br /> s <br /> firPrivy— Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) (.n <br /> ❑ Privy— Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> 10 <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) ra <br /> • <br /> r <br /> t <br /> Property Owner's Name: (,4(. tJ� 1— Levi L6-�Q . <br /> c <br /> Property Owner's Mailing Address: 3 7J \i‘k,f kd 1�. ) 5kal /VW �(8 <br /> Property Site Address: � ? S 7<( i3 k( k Pk(_,(�f� ky U tai j( n r , <br /> Contact's Telephone Number: _ QV ' J r <br /> ( G <br /> C,(1� <br /> Contact's Email: c <br /> 5� r �LAS ►"�'�{— <br /> Legal Description of Property: See A .ZL <br /> Section#: $2. Town#: 46 N Range P: f5 W Town of: ksnh "` <br /> *Attach additional page if needed fi r lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number:found on tax statement): 55135 <br /> s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY i ._ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: lg.. <br /> 1 <br /> V &hi mot 4o bt used he ht bt4 ( f awitth6K. 7 <br /> f <br /> * 0. br 2li&CLeS p rowItet sulfate_ <br /> 'i cblldul al let.Nkeuvis wl WI l dmAii4 (at Ste'. 391 i AS. <br /> z <br /> Date of staff site visit: &/'Z/.02.6 Initials of site visit staff: 5O <br /> !!! dfF° Fee Ree: <br /> Cl�� 3 all <br /> PERMIT.APPROVED BY LAND SERVICES OFFICIAL: J1,,,,} DATE:$ /T.Q2a <br /> is <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF < �J <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I x IO <br /> � <br /> 0 CIO <br /> Page l of 2 cp g . - o <br /> Burnett County, Non-Plumbing Sanitary Application —Rev 1/2020 ev <br /> KN Q <br /> 0 <br />