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• <br /> -0r <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI : 7 i� <br /> Applicant Complete All Sections Below This Line a N <br /> a C <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types V <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION '15-- o <br /> iels Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> n teK <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) <br /> O"-: <br /> O Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) NN <br /> Xi <br /> O Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) <br /> o -V <br /> Property Owner's Name: % \) NARKS U-.e_ <br /> Property Owner's Mailing Address: q-+ Q:kob\C..\ �_ BA,a Mw,v.t u 1vw .S544S I <br /> City State Zip <br /> Property Site Address: 2:2-(. 2A 6._...„ .,o. S - &t .._v i\ 5d$3-- <br /> Contact's Telephone Number: 4:1S2— 4\Z-(.t064 o E <br /> Contact's Email: C(" o.n e 6:‘,1\-A0..... <br /> ‘J vs�LQ\D . LO+v. F <br /> G AlLegal Description of Property:5w W IV <br /> I ro <br /> S N Range#: 1 5 W Town of: L4 golf e44 <br /> Section#: 32 _Town#: 3 g <br /> *Attach additional page if needed for lengthy description OR attach a co y of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 1 0 (1 <br /> cn <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY q 3 <br /> THIS PERMITS S BJECT TO ALL CONDITIONS LISTED BELOW: i (� x <br /> 014e-[ All S e-�baccel- — <br /> Q,r1al* not 4o ext ci 95.5 7' 5 00 ^ c <br /> z d <br /> I ` <br /> l 1 <br /> Date of staff site visit: 1.4 /21/?. <br /> Initials of site visit staff:, <br /> .i Fee Rec: <br /> Check#: <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: d. /OF DATE: I �O d <br /> rz <br /> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a XUu� <br /> SIGNED.PERMIT APPLICATION IN PLAIN SIGHT 5if m w <br /> Nil <br /> fi <br /> Page 1 of 2 g I � ^' <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 12/2021 <br /> tta <br /> -1 <br /> Is <br /> ro, <br />