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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: QA-A) S-7-Ark <br /> Owner's Address: �278-:2 c5/ G 7lj /7L <br /> /i� e65�er GJ� S�/� 93 <br /> Site Address: .5Am e <br /> Legal Description: �c�Sw-itJ�,S�78T�/o.J �/ �j 4J <br /> Town: Sia <br /> County: BURNETT <br /> Subdivision/CSM: — Lot No. — Block No.— <br /> PIN: <br /> o.—PIN: Q7 0,20 --2 yo ly F 03 o 0 0 ola000 <br /> Pagelndex <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 RUPSHOLM Credential No. 227691 <br /> Plumber Address: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 / <br /> Signature: <br /> Date: <br />