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CONVENTIONAL IN-GROUND POWTS DESEGN <br /> esidentiall Appllication <br /> Index and Title Page <br /> Owner's Name: <br /> Owner's Address: //Pet' c refr tO ecJ it.) <br /> c_1) /0 tio <br /> Site Address: -Tre.A-se/ .T3/4-Ajol Or <br /> Legal Description: 5 1,2, -ry evt) <br /> Town: 4.) <br /> County: BURNETT <br /> Subdivision/eSM: rre,AS.q re--TV/940c)AL lf VLot No. 47 Block No. <br /> PIN: n '7 0/ a? 414) /#2 7J-c) e,_5-6 tre0 <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 />