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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> i'esidential Application <br /> Index and Title Page <br /> Owner's Name: j;3-5(:),L) L d Ty /4"J <br /> Owner's Address: 5'6/ 7 C37‘). R <br /> Site Address: 95 7e) L wc'S i114-,J rs <br /> Legal Description: i6c1 G,L, f.3 J d <br /> Town: 5.0 S s <br /> County: U NETT <br /> Sttbd'1vision/CSM: V 7 , Y ? Lot No. Block No. <br /> PIN: n 7 03,2 vZ 9/ /5— aC C)5 0O 2 o/.2 Oc) <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 /> 'age 4 Maintenance,Management and Contingency Plans <br /> Plumber Name: WADE UF'SHOLM Credential No. 227691 <br /> Plumber Address: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-72865-/ <br /> Signature: (�/n / <br /> �� <br /> "ate: <br />