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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> � <br /> Index and Title Page <br /> 'Owner's Name: JL' r°,}G/ R e "&e(— <br /> Owner's Address: '.j 6 C.. /f"/*/e Aye- <br /> Co#45€ Grove 7,14 5-3-2)/ <br /> 6 <br /> Site Address: 90 /1''/AJ e r VA c;i' <br /> Legal Description: ,Dcl -I)(Li S' 3' T wit) /6 ccJ <br /> Town: ,5'44,455 <br /> County: BURNETT <br /> Subdivision/CSM: -- Lot No. — Block No. -- <br /> PIN: o -7 o3-? % /( 3.R a c`f ©at) o/30 cnd <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: (.1/ -►-�`�� ��" <br /> Date: <br />