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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: l' ,Q;G) <br /> Owner's Address: `16 '/e) GA-pi / <br /> �9��vrtJ�e'l"r�s X-4 rii/L) 5 5 7 <br /> Site Address: h e „zJ <br /> Legal Description: `DG l l r,L 2 S/9- "rv,:s ni L/'/Cam' <br /> Town: ,..‹-c_c57174- <br /> County: BURNETT <br /> Sst'siet✓CSM: V � / 3 e Lot No. / Block No. <br /> PIN: 02 O, E 54) /Si /7 .5 c S c c=:2 c, Aeeloci <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: 7 -� `j' <br />