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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: er4 �/t) .51-/-o�j <br /> Owner's Address: b' . -a6 �l S 7.e) <br /> / re w.� 987.2- <br /> Site Address: <br /> Legal Description: .5 4) -,5 4) 5/a i?2?'eti/1 /7 Gem <br /> Town: n-, i-! S <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. Block No. <br /> PEN: 67 006 oZ .78 17 /a 3 03 coo ©//oov <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: ‘e <br /> Date: <br />