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CIONVENTIONAL IN-GROUND POWTS DESIGN <br /> esidential Application <br /> Index and Title Page <br /> Owner's Name: L e c3 6/41 <br /> Owner's Address: 3/00 4' , eel Tr/ <br /> Site Address: min <br /> Legal tescription: pc r/G,L, 5- /3 -TWA./ ��Ze..-1 <br /> Town: err✓iS 5 <br /> County: i::URNETT <br /> Subdivision/CSM: Lot No. — Block No. <br /> PIN: 07 03 g/ /4 /3 aSc7c)f— c//Goc) <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 UFSHOLM Credential No. 227691 <br /> Plumber Address: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: <br /> Date: <br />