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AUG-23-2005 02:13P FROM: T0:9522494616 P:2�4 <br /> ��..Q�Q 8�ar-� , <br /> • ' �`�L'�f(i � <br /> ,�j�-o� <br /> CITY OF ORONO SFPTIC SYSTEM PERMTf APPLICATION <br /> Bnx 66 (2750 Kcllcy Parkway) <br /> Crystal$a�, Mn 55323 <br /> ao8 sY�•�; auuK�ss� 5� C�� . ►2:d . b <br /> Uccupancy Typc: 12csidcntial_� Cummerciat Uthcr _ <br /> Permit Type: New or Repl�ccmcnt System �100.00 �� � <br /> Rcpair Fxisting System S SU.UU <br /> (T�nkti ur nrainficld) <br /> �0.50 Statc surcharge added to above fees <br /> * See fee s�hcdulc for non-residcntiai permit fees <br /> Uwncr'sHamc: p��(WS(�C,� Q�I,t.r��{':5, �i21 - PhuacNumbcr: '7(P1j ' �]Cjj- 'lj��'!yJ <br /> Mailing Address:l3��. C.v,�.=s�w� nY. .s:��k ��.�3 city: o��r� Zip: 5�,:=�L�-t <br /> Cuntractor's Name:�G.l� C-►vuv�P ,�vY,�.Y� WQtzd/��,lnp6one Number: '1�c3 -153-3L�•Z <br /> MailinK Address:{�.�. I�D.X "�5�1 � Cii.y:cSt•f=rr.���L�5'Lip: 55p� �1 <br /> *** llU NUT MA1L PAYMENT WTT�THIS.�'PLiCAT[ON*** <br /> (:F N F:RA1.INSTRUCTiQNS <br /> I. Applica�.ions for scptic sysT.cm permits may be mailed or subrruttcd in person at the City <br /> Oflices; howcvcr, Pcrmits will nul bc inbilcd �ut_ Thc permit musl bC pickcd up in person <br /> at che City Officcs and work must not begin unlcss thc permit card is on the job sitc. <br /> Z. Permitti will b�i�suud only t�contraC[ors holding a Minnesota I'�Ilu�ion Conl.rol <br /> Agency(MPC:A)Septic System Tnstall�yrs License. <br /> 3. AlI work musl bc donc in acc;urcianc;�with the approvcd scplic syslom ci�:tiign, f�esign reporis <br /> aKe not eonsidered approved unless accvmpanied by the "City of Orono Se�tic Systcm <br /> Appruval"covcr shccl signed by the City Inspcctor. <br /> 4. The follawing inspections will bc rcquired fvr�ill septic sy�tems: <br /> A. Pre-installatioa sitc inspection to include inspcctor,iaslall<,7,and general co�nuactor. <br /> B, T�ank instull��tivn pric�r ta coverin�. <br /> C. Drainficld ttcncb i.nstallat.iun prinr to c�vering. For mounds,inspection is rcquircd a�.er <br /> rc�u�;h up bul prior lo sand placement (sand will bc ja,r t.eylc;ci for silt content),and a�a.i.n <br /> during presyure dishibuti�n Piping installati�n in the r�ck bed. <br /> D. Fina] inspection to vcrify pruper final cover depths and to vcrify that al1 purt�p stations <br /> (where required)camp�nents arc lianc�i�n�il and comply with codc5. <br /> 5. lndividual holding MPCA Installcrs Liconse shall be present dwing all inspcctions. A Z4-hour <br /> notice is required for aU inspcctiuns. <br /> NOTF: A.pplieaa�.t must initial all spa.ees. Hill in all approp�iate blanks and check all appropriate <br />