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CONVENTI JNAL IN-GROUND POWTS DESIGN <br /> esidential Application <br /> Index and Tide Page <br /> Owner's Name: ,2 //e l-t) e /s A <br /> Owner's Address: /y33‘ ki,,c✓�'5 /At% <br /> //e , 4 // 3-5-e)4/4l <br /> Site Address: 7 7/ TA,,-,7/03-0/t.) Z 4-y ,cJ <br /> Legal Description: ,s07 5– �yd, ,,* <br /> Town: J'2Gks6,3 <br /> County: URNETT <br /> S on/CSM: V,92 y / Lot No. 2 Block No. — <br /> PIN: U .7 e/ .2 YT i-5 j� ©.S 0a5' 0/V0e) <br /> Page Index <br /> Page 1 Index and Title <br /> Page 2 Plot Plan(may include septic tank and filter specs) <br /> Page 3 •istribution 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. :ox 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: <br /> Date: 3 6 — ,?� <br />