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C4NVENTIII NAL IN-GROUND POWTS DESIGN <br /> esidential Application <br /> Index and Title Page <br /> Owner's Name: Keit) /cls-5 ,r3 <br /> Owner's Address: o?6/75- cT/d 3 5� <br /> Gc) e6 3 r sy8 9 3 <br /> Site Address: 7hO <br /> Legal Description: Pte/ �E—�/1� `5 r3 Y/t�/C/ 7 t__�l <br /> Town: L //1) Coln) <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. — Block No. — <br /> PIN: o -7 ©/ 3 7 / 7 i 5 o y otic) a///mob <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 RUFSH[OLM Credential No. 227691 <br /> Plumber Address: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-77286/ <br /> Signature: <br /> Date: 3 " -o2d <br />