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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> (� l // e <br /> Owner's Name: V JC Gr�,¢ s/ 1� / <br /> Owner's Address: 6 `�vZ F/ flS/� ✓dam <br /> S-t� gal In/t) S S/� :2- <br /> Site Address: <br /> Legal Description: Q C-/ w <br /> Town: <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. Block No. '— <br /> PIN: O 7 © yo <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 /> I ,y <br /> Signature: <br /> Date: <br />