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CONVENTIONAL N-G'OUN I POWTS ;r ESIGN <br /> Residenti, ! Application <br /> Index and Title Page <br /> Owner's Name: –10.7)1 A'c' a/ /l.) <br /> Owner's Address: j a o 5 //3" >9-ye, <br /> Ro6-erf5 <br /> Site Address: g g S 755 /4/`r a6/t) ± <br /> Legal Description: S-/ 3 r 9)izi/P/ tiJ <br /> Town: T4-c k 5 CAJ <br /> County: BURNETT 1 <br /> Subdivision/6M: ff/4 L /r,o0.40) To V V , Lot No. / 7 Block No. <br /> PIN: p 7 ©/2 a yO I S /3 . /6 oZ 7a (:), 71>1)c-) <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: 7155-349-7286 <br /> Signature: (�tJc. '�6t — <br /> Date: <br />