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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: <br /> �}A) J r,LLj1 �io tr©zj-5 k1 Owner's Address: 7/l 71"' i 3a �� �'�`' Nf <br /> f <br /> Site Address: O S� Lo k�9 �l c <br /> Legal Description: _f1S 7 37AJ 7 c.J <br /> Town: cz,0 A) <br /> County: BURNETT /� <br /> Subdiviston/CSM: v � r� �? 3 Lot No. Block No. <br /> PIN: 07 ©16 a? 3 I / 7 <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: 715-349-728/6 <br /> Signature: <br /> Date: <br /> Designed Pursuant to the: <br /> In-ground Soil Absorption Manual for POWTS Version 2.0 SBD-10705-P(N.01/01) <br />