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CCN`YENTiON.AL IN-GROUND POWTS DESIGN <br /> Reside i tial Application <br /> Index and Title Page <br /> Owner's Name: &.IQD/71/. lkl'i/1 Li,5 <br /> Owner's Address: 39/ 7 /LQll)hat) ( /c?/ , <br /> Lk /)bi Lr/ ii)/ 57436 <br /> Site Address: fame <br /> Legal Description: IL)/ Pt // Jc'/ lh:Y/Q' �r (////C .z. i <br /> thy <br /> Town: _ 90(' r-) 5// %11DA1£/51, <br /> County: :URNETT <br /> Subdivision/CSM: 1 }/'M PC»c/fir-/r/J-p /Lot No.S(.p !:'.lock No. -- <br /> C/i// C.� <br /> PIN: D'7-D/ -, - -/5//-5 j5-/0.60-1066000 <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: A" - <br /> Date: 6 5- `-2 3 <br />