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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> f Index and Title Page <br /> Owner's Name: Q>e Ao D / .410v/./y 7-teif <br /> 71- <br /> Owner's Address: 2 o 3� <br /> 14-,)64,ry Wim- S-5/8.30 <br /> Site Address: ' ?3 ?L dye tie/ 7 L, J <br /> Legal Description: s/3 7 yor1,f/7G✓ <br /> Town: G/OV ion/ <br /> County: BURNETT� <br /> Subdivision/SWI: T"I'i No a 55 /f�/,e 5 A re 5 Lot No. 1 / Block No. <br /> PIN: © 7 076 A, '10 /7 /3 5- /r" Gov ol?000 <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. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: <br /> Date: 7—o? <br />