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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> / Index and Title Page <br /> Owner's Name: Ul9-I eA Thzvne5, ) <br /> Owner's Address: 5.91 W 5_2% -5 Tr <br /> ZNm6ro�.4 /n� �3'95a <br /> Site Address: <br /> E'//x of/i11erG Zo dcicr aF <br /> Legal Description: G,L, 3r S/9 T�oa4 I6 cJ <br /> Town: 0,4 Kl A-,Jo, <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. ` Block No. <br /> PIN: 07 oao a 4/0 /6 /9 Sos o03 oi/ooa <br /> Page Index <br /> Page I 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 RUPSHOLM Credential No. 227691 <br /> Plumber Address: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-349)-7286 <br /> Signature: <br /> Date: �5 <br />