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CONVENTIONAL IN-GROUND POWTS DESIGN <br />Residential Application <br />Index and Title Page <br />Owner's Name: J—a dy -5 e-A ,( e K <br />Owner's Address:c%5-- LA's e- 57> zJ <br />Site Address: <br />Legal Description: ' r y/ A) M cei <br />t <br />Town: <br />County: BURN>ETT <br />Sit4di ! <br />on/CSM:y p 6 Lot No._/_Block No. <br />PIN: Q -7 (s em Z '/l /� 3S� s' 0 5 00+ Z- 0/5 O�c� <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 Name: WADE RUFSHOLM Credential No. 227691 <br />Plumber Address: P.O. Box 514, Siren, WI 54872 <br />Telephone: 715-349-7286 <br />Signature: <br />Date: <br />