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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: ,i a/U�� C��1 L e 20'tj <br /> �� � <br /> Owner's Address: /' � � 0 J <br /> 5-5- 3 7 <br /> v <br /> Site Address: E k kel <br /> Legal Description: .5,;?5 T-,1!/J cc) <br /> A <br /> Town: "S.S <br /> County: BURN.EATQT <br /> Subdivision/C-SM: /S Ac��`� 4d s L eA AC I-e,5 Lot No. 30 Block No. <br /> PIN: y 7 a 3a � 1//16 AS.s/5- 70/ Cr;Z/000 <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 />