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CONVENTIONAL.IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: C,4CI5 aAJ <br /> Owner's Address: 76 tc> i �a••v� r <br /> Site Address: <br /> Legal Description: -5- y T�Q <br /> Town: 6 A /f4NC/ <br /> County: BURNETT <br /> Subdivision/C- - it)c_f^ G,i4 Lot No. j Block No. <br /> PIN: n 7 a.26 1 50 / o '� .5%5_ 4/46 03-20od <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: ?5-__/-7 <br />