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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> A Index and Title Page <br /> Owner's Name: /1 NSS e / �i���<2.►''Gk)47—e^ (1' <br /> Owner's Address: 078'7S/ �,�,,`/, led <br /> 4 H-4)ba/y t,✓,F S y fl5/d <br /> Site Address: 5, ,ve <br /> Legal Description: f c/ 5/5—T D,-0 /l / 5 tJ <br /> Town: TAC k5 e/c) <br /> County: URNETT <br /> Subdivision/GR. "t: 7o c>74Spr'i -74-d V. i Lot No. Jkl..?,Block No. ~-- <br /> o.7 0/,2 a '/ /5- 7 5— S/ S 7s`/ 0 V/oe,6 <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: 7155--349-7286 <br /> Signature: G/v <br /> Date: <br />