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CONVENTI+INAL IN-GROUND POWTS DESIGN <br /> 1'esidential Application <br /> Index and Title Page <br /> Owner's Name: 51c, lit <br /> Owner's Address: /3 v)( 6 <br /> 4/o bur( 1.4):47 <br /> Site Address: -.5 of 79 yy C y •-/ <br /> Legal Description: / ` S a Rp/o lci vc„,% <br /> Town: S c 0174 <br /> County: is URNETT <br /> Subdivision/CSM: Lot No. Block No.— <br /> PIN: <br /> o.PIN: 0 7 Oa a 4/'0 /7' a78 a o/ c'©o r/3v n 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. ox 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: 6'L) <br /> Date: y-/e -a o <br />