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CONVENTIONAL IN-GROUND P®WTS DESIGN <br /> Residential Application <br /> Index and'Title Page <br /> Owner's Address: Cy ��5 4�600 LX Aa <br /> _ /r'e_j 4y t- 5-07.9- <br /> S <br /> �ke .�'�4�►��ddress: <br /> Legal Description: J&_/ A)UJ /t)4) �' �-� T38,4) 17 Lc J� <br /> IL own: pj�/-eJ <br /> County: BURNE b ll <br /> S-abdivision/CSM: Lot No. Flock No. <br /> j : 7 dp6 3 17 .3-7 Z 0,2 ©ey oazge9y <br /> Page Index <br /> Page I Index and'Title <br /> Page 2 Plot Plan(may include septic tank and filter specs) <br /> Page 3 <br /> Page 4 Maintenance,Management and Contingency Plans <br /> c-11-unber Name: WADE RUFSHOLM Credential No. 227691 <br /> flumbex Address: P.O. Box 514, Siren,WI 54872 <br /> Telephone. 715-349-7286 <br /> Signature: <br /> Date: <br />