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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: �� f <br /> Owner's Address: 67,1^("4:5474) <br /> 7 <br /> Site Address: <br /> Legal Description: 5 7 yG� a 4x <br /> Town: — <br /> County: BURNETT <br /> Subdivision/CSM: ___ R ,'d c= r- c-�,tl k 5 Lot No. 7 Block No. <br /> PIN: 67 0�2 %' /6 (, 1 .5- /5" 4166 o16 0 ole,) <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 /> P9 5 P 4,111P -t,4-,0k <br /> /'0 6 /6y',P c 4 r we. <br /> Plumber Name: WADE RUFSHOLM Credential No. 227691 <br /> Plumber Address: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> r � <br /> Signature: �L)e«.� <br /> Date: <br />