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CONVENTIONAL IN -GROUND POWTS DESIGN <br />Residential Application <br />Index and Title Page <br />r r a <br />Owner's Name: <br />Owner's Address: <br />Site Address: <br />Legal Description: �G ( Nr✓ /� �� �3y/� /P�� u J <br />Town: <br />County: BURNETT <br />Subdivision/CSM: Lot No. r— Block No. <br />PIN: 3916 /� o/ 00c> 006 <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 />Py s Pw/nP <br />Plumber Name: WADE RUFSHOLM Credential No. 227691 <br />Plumber Address: P.O. Box 514, Siren, WI 54872 <br />Telephone: 715-349-7286 <br />A <br />Signature: GL,% ccs <br />Date: <br />Designed Pursuant to the: <br />In -ground Soil Absorption Manual for POWTS Version 2.0 SBD -1 0705-P(N.0 1/0 1) <br />