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CONVENTIONAL IN -GROUND POWTS DESIGN <br />Residential Application <br />Index and Title Page <br />Owner's Name: G� ji�%c� y i 7Z <br />Owner's Address: -,:;2 Y_3.: /, /dr_ T-5— <br />Site <br />Site Address: <br />Legal Description:�� <br />Town: <br />County: BURNETT <br />Subdivision/CSM: <br />.o <br />Plumber Name: <br />Plumber Address: <br />Telephone: <br />Signature: <br />Date: <br />Lot No. Block No. <br />Pagelndex <br />Page 1 Index and Title <br />Page 2 Plot Plan (xray include septic tank and filter specs) <br />Page 3 Distribution Cell(s) Cross Section <br />Page 4 Maintenance, Management and Contingency Plans <br />P.O. Box 514, Siren, WI 54872 <br />715-349-72286 <br />1-104-4-111,1-104-4-111,`` <br />:1G s, <br />Credential No. 227691 <br />Designed Pursuant to the: <br />In -ground Soil Absorption Manual for POWTS Version 2.0 SBD-10705-P(N.01/01) <br />