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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> esidential Application <br /> Index and Title Page �c <br /> Owner's Name: S4/5/9-/t) e;^ /ve 77" <br /> Owner's Address: V57 I//9//ei 491 <br /> I I eJ (.04 1J5 /' 5 SSP 6 <br /> Site Address: acy 9 .2 3 e i -.i d er1 i LTJ <br /> Legal Description: 5 Y5-7—(1//1.4/6 c.J <br /> Town: S u�/e5 5 <br /> County: URNETT <br /> SubdivisionlC-�lbg: /Pj i� y Lot No. S :dock No. -- <br /> PIN: o7 o3-Z a // /b j5' 3- /5l oy9 o/8G coo <br /> Page Index <br /> Page 1 Index and Title <br /> Page 2 Plot Plan(may include septic tank and filter specs) <br /> Page 3 tistribution 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 />