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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: rt ha ted 36,.' <br /> Owner's Address: / 3Y 7 -C6✓4 fu W .e- 77' <br /> / L{ ci50, 3 jJ, <br /> Site Address: j of y5 c <br /> f-r <br /> Legal Description: /06 . 4 /3 S'N/f' /3-7-t) <br /> Town: 1-/4cC'//q -e_ <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. Block No. <br /> PIN: D 7 c9iy 33S / .5 G `L) / 0 0 0 v/I''c.'O <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/ /1 <br /> Signature: <br /> Date: / — -- 2 <br />