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CONVENflINAL IN-GROUND POWTS DESIGN <br /> esidential Application <br /> I Index and Title Page <br /> ' <br /> Owner's Name: -J,4-cre-Ai S f7 a/`e, <br /> Owner's Address: 02 g'sa/ CAR ` 1 /161 <br /> 4 4101 u ry 5-41 g 3 o <br /> Site Address: s,4-n'I '_ <br /> Legal Description: 73/0/(J/f'/ <br /> Town: f"c k S d,3 <br /> County: :URNETT <br /> Subdivision/CSM: Lot No. I;lock No. <br /> PM': D7 c1/42 a yo 006 o///oo <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: vv <br /> Date: e -02 a3 <br />