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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> 4"esidential Application <br /> Index and Title Page <br /> Owner's Name: B.it)/S .5//ho.v_5 e'er} <br /> Owner's Address: 88'S/ Gr/ f-,4 AV <br /> S/re pi) e-✓', 5/F 7 . <br /> Site Address: ' 7-5 <br /> Legal Description: /L1 —/tJ J S 023 TOR/o/e/7 r.J <br /> e. <br /> Town: 64-/uie.S <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. — :lock No. — <br /> PIN: p 7 too d 3 g17 .23 o/ ood o/%od <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 /> P9 S Poo,/° chAmher <br /> P9 6 P yet c-arve_ <br /> Plumber Name: WADE RUFSHOLM Credential No. 227691 <br /> Plumber Address: P.C. Box 514, Siren,WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: aoae- <br /> Date: o2y <br />