Laserfiche WebLink
z <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County, WI " �d <br /> Applicant Complete All Sections Below This Line 0 a yC <br /> a <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types 1 <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION <br /> Z 9 <br /> JPrivy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) ~. <br /> ❑ Privy—Vault Toilet (Must specify volume in gallons: (Minimum 200 gal)) <br /> ❑ Composting Toilet System (Must demonstrate unit is approved for use by WI DSPS) <br /> ❑ Incinerating Toilet Device (Must demonstrate unit is approved for use by WI DSPS) (` <br /> Property Owner's Name: a In r. --1 h ock-c, ' <br /> Property Owner's Mailing Address: 2 t.3"5 to I St 54 r a-.s F c c- w S''n37 0\ <br /> City State Zi <br /> Property Site Address: 4 SC) Lk S 0.1 1,0,r 5 n . ' i`/il- i VI S7.2 r) <br /> E <br /> Contact's Telephone Number: 1 i 5- ."1 1 — n 0 g c <br /> Contact's Email: p +1 v‘ie..- P. A 0 .s D vtri.i , Le ny, <br /> 4 O <br /> b <br /> Legal Description of Property: 1 6- LS KA S 3 7$ '3 ® P 3 l a I' <br /> Section#: j (, Town#: ?j 43 N Range#: i aT W Town of: �A -Ft‘I� -€. <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* _J' <br /> Tax ID#(1-5 digit number;found on tax statement): r7 � c N <br /> r <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY S' c 3 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: H <br /> l Pr'ivy mus-- ern-e.e.+ a,UL S--i-bat s • <br /> 1. <br /> W - v,� <br /> -- <br /> t ri . S 241 i CST-2i-t- l9 $ <br /> C3 4, are no ftrvni+d Iutbi 5-Iiuc-ores or, -,-t s pa,rc.e a <br /> z <br /> Date of staff site visit: I /zvz N Initials of site visit staff:i`� 2 <br /> �� ,�_.Fee Rec. /5C� <br /> PERMIT APPROVED BY LAND SERVICES OFFIC d: /( ,./1,2 DATE:/O//y/2 2 :ice 1422 <br /> r J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 1 � c= <br /> S m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a Q <br /> 9 0 � <br /> 00 <br /> Pagelof2 <br /> Burnett County, Non-Plumbing Sanitary Application—Rev 12/2020 0 1 ___�I1 <br />