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CONVENTIONAL IN -GROUND POWTS DESIGN <br />Residential Application <br />Index and Title page <br />ONvner's name: ///FFG /'/ mAl <br />Owner's address:3�l ✓g V4N C�t�N�f✓QUe- <br />,QzAv1�� <br />Site .Address: <br />Legal Description: %Ki z7a <br />7i/VN NAI dyJ <br />Town: 0ak1-?0'yd <br />County: /411vatt- <br />Subdivision Name: )eN%N,3 1q�Z40iG �aV Lot No. 2 Block No. <br />Parcel Identification Number: /15'- 2j(16-QZ1000 <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 Natne: eO-5e,f 4 1�4Qr Credential No. <br />Plumbew-Address: _77,720 ;TQ131/Sav / <br />t' - w 3 <br />Signature: <br />Date: Phone No. 7/57_-`,7 45-0.;7-04 <br />Desiened Pursuant to the: <br />In -ground Soil Absorption Manual for POWTS Version 2.0 SBD -10705-P (N.01/01: R. 10112) <br />Nacre 1 of <br />