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iv <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI 7: N' ;,, <br /> Applicant Complete All Sections Below This Line = E c <br /> d <br /> ' Check Type of Non-Plumbing System/Device; Fee is $150 for All Types P.CD <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION o <br /> X Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) :'---,,,-( <br /> l <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) i <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> it <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> II <br /> Property Owner's Name: R C) Q f t 5 11 C C L u l e <br /> 1 <br /> Property Owner's Mailing Address: E/ 2- 9,"' Lu,e,..5. /',-, mi i',AAy Sb&re.o . r'1 (y <br /> City State Zip <br /> Property Site Address: tl .3 (y 9,, cis— to /-j, u 4e,-,...,4 mo p' geif ¢-/i/k n <br /> Contact's Telephone Number: G $ / - lb y y &co 3 / <br /> -Ti <br /> Contact's Email: r.5 Ai G 13 y y .9. r►,A t L, r a m <br /> `O <br /> ' <br /> Legal Description of Property: ' <br /> Section#: ,2., G, Town#: Uj j N Range#: /é W Town of: S.t-4.,1 S 5- <br /> IQ <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): a. 1 9 6 <br /> CA <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °=N <br /> THIS PERMS I SU C A L CONDITIONS LISTED BELOW: H <br /> - -0 li 0 c <br /> i, \ <br /> Sk9 elf\ r-j\L <br /> Date of staff site visit: -----1 .---L9" als of site vi• taff: — <br /> Fee Rec: 757) <br /> --fr-A„,„ ,,,,i <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: ; . . DATE: <br /> r - <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF .W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - A Q Effil <br /> 0. <br /> N =33 <br /> CD <br /> Page 1 of 2 <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 1/2020 <br /> v <br /> u, <br /> i <br />