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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> esidential Application <br /> Index and Title Page /}/� <br /> 0,vvner's Name: T/I'M GSo.J 6?) 1/�e, I <br /> 3wner's Address: 7C G errs e,7Le.r' ,e <br /> y <br /> S, /'e•° w.Vv 5-4/8-7,2 <br /> Site Address: 5/0, -4).9 6 e r <br /> y <br /> Legal Description: Ar— / S cc1 —56 5 3 %3"-0 t 7 cJ <br /> _,o,,rn: ID ifit) , e S <br /> County: BURNE T T <br /> Subdivision/CSM: Lot No. ® Block No. <br /> : 070a4 38 /7 c53 "ziO3 ooa o / oci <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 RJFSHOLM Credential No. 227691 <br /> Plumber Address: P.C. Box 514, Siren,WI 54872 <br /> Telephone: 715--34/19-77228866- <br /> Signature: <br />