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CONVENTIONAL IN-GR"ONND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> f / . <br /> Owner's Name: Xr i/i Ay fa/d i.'v S LL C <br /> Owner's Address: 6O r GA- f"f t E I /4 O e- S <br /> MpL M AI, o <br /> Site Address: j 7 9 12 GTy <br /> Legal Description: �pc r �'r,`, Li-V _5 A6 -t- 3 r go e/7oJ <br /> Town: G/i2J/D/t) <br /> County: URNETT <br /> Subdivision/CSM: Lot No. — Block No. <br /> PIN: o 7 036 4ta /7 A Z 05" ov/ o//oDd <br /> Page Index <br /> Page I 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: --a -oz.2 <br />