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� 1 <br /> ��ti��%�/�� ^ / <br /> � 1 � � O�� C�R��N(� <br /> r .SL�et Acldress: ilR�ailinc�Adirress: le�e�har,� ;452;`'1.4.;tf,;.,ii <br /> � � �!5(7 Ke�lay Par±cway 'O. i3ox f�o F�x (95� !Y9-qbto <br /> .��.� C-•ono, 1`��N 55�356 �rystai F>ay 'N ii3�3 ��v���.�i vr'or,o.�Yir�.�y <br /> ,���� ' <br /> Septic System Permit Application <br /> Please c�mplete this applicaton completely. Failure to fill in all of the required information may <br /> result in a delay of processing your application. Submit this application, a complete copy of the <br /> site evaluation and the design at least 3 working days prior to the projected installation date. <br /> Site Address: J�j �y`1 � 'r /f.Y ,., <br /> � I �1�% �r��t <br /> Owner Name: � , � " Address: �� ��-2 <br /> Owner Home Phone: '�Z- �j � � 7 Work Phone: <br /> Desi ner: License# <br /> Desi ner Address: <br /> Email: Phone: <br /> Installer/Contractor: f ' ���-- License# � ��1 <br /> Installer Address '"` = Date to be Installed: <br /> c�YS.+w., � c.o�,1 . �, ,_ ,� - <br /> Install Email: f.� 1��� es •�� � Phone: /� � ;�� <br /> Existin Se tic S stem E es: ves No Com liance Ins ection Date: <br /> General Lot Dimensions: widtn� oeptn: Total Area: (,acres or sq tt) <br /> Home T e: d'� i� f i^ � -, ,� #of Bedrooms (> <br /> Washer Water Softener Garba e Dis osa/ i Hot Tub/Whirl ool Dishwasher <br /> Well: Existin9 New (to be installed) �� Size of Casin : De th of Casin : <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: Sizing Factor: <br /> Septic: New Replacement Addition Other <br /> Tanks: Qty: _ New Existing Total <br /> Tank Type Capacity Manufacturer <br /> Pump Station: Tank Type C�?c, Capacity r S C� �O Manufacturer � ,-�� <br /> (if applicable) Pump Size Type Failure Alarm Type <br /> Drainfield Total Length Total Width Maximum Depth <br /> Trenches w/rock Trench w//chambers <br /> Rock below pipe inches <br /> Pressure Bed Mound Other(explain) <br /> Mound Dimensions: Rock Bed x ft Absorption Area x ft <br /> Clean Fill below rock bed inches <br /> Filter: Type d� Manufacturer Alarm Type: <br /> New designs shall adhere to 2008 MPCA standards. <br /> OFFICE USE ONLY <br /> Permit# �����4�3?�t Payment Rec'd '�.� � Zoning District 'R'R' �(� <br /> Field Checked � Date Inspected New/Replace <br />