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BURNE"rT COUNTY ZONING ADAIINISTRATION <br /> 7410 COUNTY ROAD-K, 4102 C <br /> SIREN, WISCONSIN 54872 <br /> •715-349-2138 —� <br /> ) <br /> NON-PLUMBING SANITARY PERMITAPPLICATION ($150) <br /> PORTS CONNECT ON/RECONNECTION (S50) <br /> Applicutiun Information(i,pe or Pring ATTACH A PLOT PLAN WITH THIS APPLICATION <br /> pnpen Owner N'amc Pmvony lsgal Des.,..... <br /> - - 6wck ri `� '�IN lir I/a I;a.sZs.r •.n w <br /> PniplyOwnds AIDiIIn6 AdAre.. lot 6innher Iflurk Nunibv <br /> L.-J��� CCl K�1eVJ Ct <br /> n"d.....on Nan.nr csH Namb.. - <br /> UnOIUkeS, Ml�I SSD3`(, , NI2,N6114 <br /> _ TsJlc of Building: (Check one)❑ State-O,.nd ❑City <br /> E( lor_'Panily llwcllfng-No-of licdibonu-�_ ❑A'illagc - U <br /> ❑ public v� EfTax„nr�0.l.K5C(� rrevanq <br /> Public Building/land Use, ILxplain lhf us�parpnss fannis pvrriih.f.c` Pared l'a.Sumbet(s) <br /> mtpyroaw,Ine-1. e—eil lemmai„memcante,e)15-5-o5-Co1— <br /> " n C by , "on lay <br /> 'type of 1'ennic '1'rpc of Nmt-Plumbing Derice/SystendPnilet/Unit: <br /> ❑,,%ru Plumbing(Prixr.Toil",Kanoomct,) ❑ Pricy-Pit Toilet ❑ Composting Toilet Systcut <br /> L9 PORTS Kecanncction ❑ Privy-Vwdt Toilct(Vault sill: ElIneinereling Toilet Device <br /> ❑ POWTS Kepair CO0O1y-� � gallons or _cubic yads) Cl Tunable Restroom Unit <br /> ❑ Revision Slate p ❑ Other <br /> W.ponsibililr StntemenC (Check one or both as appropriate.) <br /> the unit s.',n d ussumc re poo:ib I't forth I OR'1'1 laity f h' h e -p t "..& <br /> �h the unJ.tsien d,a autne res onsiM1 lin br the tmtallauon of th n lambing snatan sntem for which this ernet n issued. <br /> Pinnds�Owuvi Nan,(,nn?,,, Plni bc'dtlendsSibnwutin Nn,u'us," B......ss m,nc Nombre: <br /> �rr2Ry W4 MU,-t.4 / 35(J -�1 7/>=3119-25-3 <br /> Planners AAArns(SrtaL Ci,Y.State.Zlp Cnael: <br /> Z-L77U MORS& Rb so2i-W W; c Utis -7Z <br /> O(lice Use Ont,: <br /> ❑Di,nppmad Pcm,it Pee CST Na Ihte LsuuJ Lisuing Agem S,..io e <br /> . �Appro,d ❑D..nerci.en Initial Ads. e SD.�o /��� <br /> 0.v <br /> Conunerib: <br /> Fk)r P�A/J N�r�D�e2uflT�r A)bQ- WOS rr sugmfffED �4 <br /> P(urqe <br /> edition,of Approval/Beacom o <br /> for Diaapprvul: _ <br /> 711,(,5! con/TR6f C2)"TV �F�K Cod n/ELrtcoJ /�7RD�, QED ���� <br /> WE <br /> P(ZtoNN— TD (3r�LGF/cun1G `O INGKK GocATianl o� ) D <br /> ice, /i✓SP.- -1b (I'LtrCoaE WILD LD OPONOV 014 <br /> Ro koi G'1IfR - .J,� /J/Vu r-� <br /> 1DCl ISG BURNETT COUNTY <br /> ZONING <br />