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CONVENT'.NAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: 75414 / V c' L Ke. -rr 3 <br /> Owner's Address: /3v2 7 / / /VE /t <br /> , -,uciov, -(` m/1)- <br /> Site Address: df 07 y635" M iA)e-r t/I ;(- <br /> Legal Description: ice /6,41_"3 7-y/A) R 16 cd <br /> Town: sw/S 5 <br /> County: BURNETT <br /> S e4/CSM: V?? P '?.a 3 Lot No. , 2 Block No. — <br /> PIN: <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: /0•-13 :Za <br />