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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: <br /> Owner's Address: <br /> Site Address: <br /> Legal Description: P,/ 7-_7 ,9z-t) <br /> Town: _ e e-,_)a <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. Block No. _ <br /> PIN: <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: 11.0. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: e1j a <br /> Date: 14— �/'r�� <br />