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CONVENTIONAL IN -GROUND POWTS DESIGN <br />Residential Application <br />Index and Title Page <br />n � <br />Owner's Name: c�t/ !j A-isL <br />Owner's Address: <br />Site Address: <br />Legal Description: .S % _ 3 % �IQAJ <br />Town: LTG<S c� rrJ <br />County: DUIZN ETT <br />�/� s-a <br />Subdivision/GSM: e c}��/'e� /`t��N/ ��� �/. Lot No. Block No. <br />Plumber Name: <br />Plumber Address: <br />Telephone: <br />Signature: <br />Date: <br />Pagelndex <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. ]fox 514, Siren, WI 54872 <br />715-349-7286 <br />