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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> i r <br /> Owner's Name: <br /> Owner's Address: 5/-3 3 �)- O,4eJ e'U�/Sa.�J f d <br /> 7 2- <br /> Site Address: �/¢m <br /> Legal Description: _A� l S —104 .S,7 y T-72/0 A"/7 &.1 <br /> c <br /> Town: �9i�/�I S <br /> County: BURNETT c� <br /> Sobdivision/CSM: V,?7 o / 7 Lot No._,.�Block No. <br /> PIN: o 7 0o 6 W- -75 17 94 1 a y 000 0.15—1 cv <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: 715-349-7286 <br /> Signature: <br /> Date: <br />