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CONVENTIONAL IN-Or le UN II. POWTS +I�ESIGI�i <br /> Residential Application <br /> 'index and Title Page <br /> Owner's Name: / / .5. A.) Ue� e.r <br /> Owner's Address: 2 8 s 5 r's A LA) <br /> 4),4.s - A),,/--0 .7'L-. 6/5 7/ <br /> site Address: eg3Cs k;/1( , '/ <br /> Legal Description: /0c. G, L, / 3 7-'yv r),10 ceJ <br /> Town: TAC.,I(Soit) <br /> BURNETT <br /> V 9 o237 Lot No. !:;lock No. <br /> ?TAT: 07 0/ yd /,>o'3 .c o.5— cal c,/Y c <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 /> t? Mm:er Name: WADE RUFSHOLM Credential No. 227691 <br /> number Add ess: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: %. <br /> Tat.. / -aS'--a <br />