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c <br /> NON-PLUMBING SANITARY PERMIT APPLICATION —Burnett County, WI v N <br /> Applicant Complete All Sections Below This Line E.. o W <br /> d <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION o <br /> 2/Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> o <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) 9,p <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) R <br /> El Incinerating Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) A <br /> Property Owner's Name: W( A e2 \(U(,Crjk ffiA(r5 i\e S <br /> Property Owner's Mailing Address: ep._( (2,g-7 5 r(f C,(-t i?ci W -Rekdkec . Or 31��' r� City State Zip? -g3 <br /> 7 <br /> Property Site Address: �G�� ��IGLAOvY1 �w4j►,n c' <br /> Contact's Telephone Number: —1 ( 5- "Tao`11 o LF o A <br /> Contact's Email: {rp wl nI.QSK.�ou S ' lo51/./p . CO —D <br /> **If staff has a question abou t is application,you will be contacted via email. Make sure your email address is b t <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and =' <br /> @BurnettCountyWl.gov ( V22.61 <br /> (,j 4 <br /> Legal Description of Property: ` ? 2 t( 22-61 P i 6-K-7� 0 <br /> Section#: \1 Town#: N Range#: W Town of: I v-c Lc9- - - Fvf <br /> 31 g l c.„ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 2 3441 3 c i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY t 5 d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: k � N <br /> OMerf aAA 2,-f-lala-s ,_l r° ., <br /> y`1i is pri1nf ran n - bt d'v ti -l-ti n 62, int,t/us based an - k1 o( r-l-h c z <br /> w Ott fiord-lirloj -ruc-kw- -Poi 3or„15 2. 3-Fre4 t SU,i-1- Lble 30)l is re7tc:red. ''' , <br /> Wo0 <br /> Fee Rec:t'5_ <br /> 5 Check#:bOt k <br /> Date of staff site visit: / 1'�/2023 Initials of site visit staff:gT- r l��'=� <br /> i <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAIfi DATE: I/ I.II2• , < n ---.._. -..-..--. <br /> Fzi <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y 513, ` 0 <br /> NJ MI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD -. <br /> �� 0 20 <br /> Pagelof2 U g ' <br /> m Ind <br /> Burnett County, Non-Plumbing Sanitary Application—Rev 12/2022 < R. <br /> rn <br /> J) <br />