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CONVENTIONAL IIN-GRSUND POWTS DESIGN. <br /> Reside4Itial Application <br /> Index and Title Page <br /> Owner's Name: hIck L rcJ <br /> Owner's Address: 02,2 99 5-7,1€ r, fJ L,0 <br /> /6,4_,/- 537/ Cf <br /> Site Address: 9 7/ j4 CJ e <br /> Legal Description: L, 1 /. <br /> Town: TA-c-Ks' ,-J <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. — :lockNo. <br /> PIN: 07 o /2 .2 Ye /-5- 0/ 53- c9o/ /c9on <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 />