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t <br /> t <br /> p'o�, <br /> REee� n <br /> OQT 14 7014 CITY OF ORONO <br /> CITY OF ORONO streelAddre-, <br /> Mailingaddr T®lephcn[+(9s2)249-ibQo <br /> 2750 Kelley Parkway P.O.Box 66 Fox (952)249-4616 <br /> Orono,MN 55356 Crystal Bay,MN 5537-3 www.d.orono.nn.us <br /> .- <br /> Septic System Permit Application <br /> Please complete 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 /> Pro Owner: 'r}N 6, g Email: <br /> Maifing Address: <br /> Phone: Cell: 12- 221 77 Work: Home: <br /> Designer: I Z-2 015l License#Ni Y Email: Phone: <br /> Installer/Contractor: License# OEmail: Phone: <br /> Date to be Installed: m &To/5 i;/g S - <br /> Property Address: W C"-0.v+0 W I, F<Q <br /> Existing Septic System Eyes: Yes S, <br /> Compliance Inspection Date: <br /> Parcel: (if no address) <br /> General Lot Dimensions: Width: Depth: Total Area: (Acres orsq ft) <br /> Home T #of Bedrooms: lothes Washer: ater Cond: <br /> ,,Garbage Dis sal: Hot_Tub/Whir ol: Dishwashers <br /> Well: Existing New(to be instaNed Size of Casing: Depth of Casing: <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: -1Ivv-- Sizing Factor: ,C-0 <br /> Septic: New Replacement Addition Other <br /> Tanks: Qty: __J New �! Existing Total 3 <br /> Tank Typ( Capacity 17 <br /> >oo (z Manufacturer <br /> Pump Station: Tank Type(Acres Capacity3 0o Manufacturer 4v�iv„ <br /> (if applicable) Pump Size d/L�— Type u go(S Failure Alarm Type <br /> Drainfield Total Length Total Width Maximum Depth <br /> Trenches w/rock Trench w//chambers <br /> Rock below piper'] inciczS K <br /> Pressure Bed Mound <br /> I/ Other(explain) � <br /> Mound Dimensions: Rock Bed jLa x ft Absorption Area L3_ x 2-o ft <br /> Clean Fill below rock bed Z2 inches <br /> Filter: Type Manufacturer Alarm Type-.- <br /> New <br /> ype:New designs shall adhere to 2008 MPCA standards. <br /> OFFICE USE ONLY <br /> Permit# a0/ D//90 Payment Rec'd Zoning District - <br /> Field Checked Date Inspected New/Replace <br />