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CONVENTIONAL IN-G'"OUND POWTS DESIGN <br /> ►'esidentiial Application <br /> Index and Title Page <br /> Name: , <br /> 7WeJ Gee/7ec <br /> Owner's <br /> Owner's Address: /75 d e-e <br /> S,00Ner li✓x q , <br /> Site Address: e <br /> Legal Description: /S J --AU w s,n 7'3?Ai `f <br /> Toy. k ..I s k <br /> County: BURNETT <br /> 73 CSM: Lot No. 02 Block No.— <br /> aa: 07 o.Q a 39 /y / 5a o3 a)al o <br /> Page Index <br /> Page 1 Index and Title <br /> Page 2 Plot Plan(may include septic tank and filter specs) <br /> Page 3 :IPistribution 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: <br />