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CONVENTIONAL IN-GIP ITN* PliWTS tESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: 4i),in) /4;,i)0, e <br /> Owner's Address: if 72, /3/4- /') <br /> 54/YOI <br /> Site Address: - 4-M <br /> Legal Description: /3 / C, 3 5/a „J.: ,e/Li J <br /> Town: 5 c.e) //— <br /> County: zURNETT <br /> Subdivision/CSM: Lot No. Z lock No. <br /> PIN: 0 7 o2 4/0 /r 3 <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 RUIFSHOLM Credential No. 227691 <br /> Plumber Address: P.O. Z ox 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: <br /> Date: <br />