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CONVENTIONAL IN -GROUND POWTS DESIGN <br />Residential Application <br />Index and Title Page <br />Owner's Name: TAC.,K o7z/-"— <br />Owner's Address: 6-W S /ti 70 <br />5 y.'9 3 <br />Site Address: <br />Legal Description: a L l C-. L- -rF %AJ <br />Town: yYj "ge ea_ ^j 0 •j <br />County <br />Stt�CSM <br />Plumber Name: <br />Plumber Address <br />Telephone: <br />Signature: <br />Date: <br />BURNETT <br />d ! Lot No. a2 Block No. <br />0 7 0 /Y L 36 S o -s 0D3 D/G oov <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 />WADE RUFSHOLM Credential No. 227691 <br />P.O. Box 514, Siren, WI 54872 <br />715-349-7286 <br />