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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> i s esidentiai Application <br /> Index and Title Page <br /> Owner's Name: ,4-Jc/Pe_K) Cirf/y�'e <br /> Owner's Address: y0 '; 3 c GJ e_rt%+cc9 c r /`1 A v <br /> • 5 Sy a U <br /> Site Address: dZ 7 7 � J•e 5 S /9- ID r• <br /> Legal )>escription: 5 3 3 Tyo/t) k f 6 (.c.) <br /> Town: 0 A-k)/4 Ncil <br /> County: BURNETT <br /> Subdivision/ ' 5 ;<..- Add Lot No. /3 Block No. <br /> PIN: G 7 0 i2C5 /t 3 5-7.5 36.2 0.23 c>c_ <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: <br />