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e ro b <br /> NON-PLUMBING SANITARY PERMIT APPLICATION—Burnett County,WI ti <br /> 'a m <br /> Applicant Complete All Sections Below This Line <br /> a d <br /> Check Type of Non-Plumbing System/Device; Fee is $150 for All Types 0� <br /> A PLOT PLAN MUST BE INCLUDED WITH THIS APPLICATION a <br /> ❑ Privy—Pit Toilet(Must be accompanied by one soil boring from a WI Certified Soil Tester) <br /> ❑ Privy—Vault Toilet(Must svecify volume in gallons: (Minimum 200 gal)) <br /> Composting Toilet System(M st demo trat unit is approved for use by WI DSPS) <br /> 4t -ear 5 <br /> ❑ Incinerating Toilet Device(Must demonstrate unit is approved for use by WI DSPS) <br /> Property Owner's Name:�"�`' o <br /> Property Owner's Mailing Address: <br /> City State Zip <br /> Property Site Address: n <br /> Contact's Telephone Number: <br /> Contact's Email: C✓tel y/t$�� ���� G�rr��Crf��l�t/hS �G��Y! v t <br /> m <br /> io <br /> Legal Description of Property: <br /> odo <br /> Section#: Town#: N Range#: W Town of a \ <br /> *Attach additional page if needed for lengthy description OR attach//a,,copy of the deed OR attach tax system property page.' <br /> Ot�S� t7 1 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY 1 <br /> JTJ <br /> THI� PERMIT/I,[S SUBJE5jT TO ALL CONDITIONS LISTEDBELOW: y <br /> d <br /> n <br /> Q <br /> Fee Rec: 5- <br /> VJ <br /> y <br /> 0 <br /> Date of staff site visit: Inti of site vis taff: /d-A N <br /> °z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: '1/1 <br /> > D ^� <br /> z Nm M lid <br /> j Zo <br /> r <br /> fJ O ti o <br /> Page 1 of 2 c z o <br /> Burnett County,Non-Plumbing Sanitary Application—Rev 1/2017 M <br /> m <br />