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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> p Index and Title Page <br /> Owner's Name: A /41 C / 1,4> <br /> Owner's Address: /J oX &O v/v) <br /> Site Address: 1,5v66 ') <br /> Legal Description: QC <br /> Town: ej <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. — Block No. "— <br /> PIN: 0-7 0A84-2 .Tr/G 3 d y c5 a�/�00 <br /> Page Index <br /> Page 1 Index and Title <br /> Page 2 Plot Plan(may include septic tank and filter specs) <br /> Page 3 Distribution Cell(s) Cross Section <br /> Page 4 Maintenance, Management and Contingency Plans <br /> Plumber Name: WADE RUFSHOLM Credential No. 227691 <br /> Plumber Address: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-34491 / <br /> -7286 <br /> Signature: /'V `�' <br /> Date: Y a V 6 <br />