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CONVENTIONAL IN-GROUND POWTS DESIGN <br />Residential Application <br />Index and Title Page <br />Owner's Name: G A• w r e ," <br />Owner's Address: 7e o,5- C e r'C o k <br />�i 65�e r w -T 6-vg9­3 <br />Site Address: <br />Legal Description: <br />Town: Z_ <br />County: BURNETT <br />Subdivision/CSM: Lot No. '— Block No. <br />PIN: 07 o/6 a-3 9/ 7 0/ / o y 0042 c,16_0,942 <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: <br />Signature: <br />715-3`4-9-7286 <br />(�' <br />Date: `J_` –7 11� <br />