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CONVEN'1 I NAL IN-GROUND POWTS DESIGN <br /> esidential Application <br /> Index and Title Page <br /> Owner's Name: Gary C e•no) S <br /> Owner's Address: � �o A.2(5-c> ro(4) <br /> �'Icid :5 'n- S37// <br /> Site Address: , :7•7 7c05— % 41 <br /> Legal Description: iCld G-. L9O')/P / <br /> Town: A'ck.S 0,-J <br /> County: :URNETT <br /> S ision/CSM: .1// /_ 4 Lot No. Q Block No. <br /> PIN: o7 04 510 S 0 S 065- c�©c)06 <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. :ox 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: 4/61_01_,74, <br /> Date: 7 <br />