Laserfiche WebLink
` ', <br /> , ' ����I��� <br /> OCT -3 2014 � p� <br /> �.O�a � <br /> crnr oF oRONo C ITY �F RC}N� <br /> ,,p y a�re�t�1dcFrqss: t�R'af6in�Ae��c�s: Tcslr��h�n�(9�a2)2�9-��6497 <br /> ��, G� 275tA Kc311try Paekva�ey F?U.�ax bb � F�x IQ.rz2D 3e10-�b�b <br /> `�k�SH��� 9r�rso,M� 553§� Crystal Bay,M!ti 55323 �vvuua.a.orono,rrre�,� <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 e Owner: ~ , k�r-`, Email: <br /> Mailin Address: �,2 � e �Q� Iov� �d/�p•1 /'V►� h< <br /> Phone: Cell: 6�2' ''Y�' y ork: Home: � �'W l' <br /> Desi ner: �-� �es�d�ti License# Email: Phone: ��J 7 y (oL� <br /> InstallerlContractor. ��y5$''�'��'�"License# .��3Email: �" Phone:,�2� �77�-/- 3`� <br /> Date to be Installed: � 1�ti''�n\�� �� 4�- ��i� - 3 5��ea►1 <br /> Pro e Address: �� � <br /> Existin Se tic S stem E es: Yes No Com liance Inspection Date: -2�'—� <br /> PB�CeI:('�fno address) <br /> General Lot Dimensions: Width: De th: Total Area: acres or � <br /> Home T e: �,�. el #of Bedrooms: � Clothes Washer. Water Cond: <br /> Garba e Dis osal: Hot TubMlhi ool: Dishwasher. <br /> Well: Existin New to be insta��e Size of Casin : De th of Casin : <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: C I Sizing Factor: <br /> Septic: fVew eplacement Addition Other <br /> Tanks: Qty:_ e�n a� Ov�p xisting t o�v Total �.9a� C�c1 <br /> Tank Type � Capa Manufacturer <br /> Pump Station: Tank Typel.�.�e�.Capacity t��� �0�.[. Manufacturer e, Rl� � <br /> (if applicable) Pump Size�1 Type ?,�e1�e.-- Failure Alarm Type .�'/Q�r,o,e,� � <br /> Drainfield Total Length Total Width Maximum Depth �; <br /> Trenches wlrock Trench w//chambers v <br /> Rock below pipe in K <br /> Pressure Bed Mound Other(explain) <br /> � <br /> Mound Dimensions: Rock Bed � x �3 ft Absorption Area Z'� x _�� � <br /> Clean Fill below rock bed l�. inches <br /> Filter: Type �1i4 Manufacturer Alarm Type: <br /> New designs shall adhere to 2008 MPCA standards. <br /> OFFlGE USE O Y �('� <br /> Permit# D/ -�l��` Pa�rment Ree'd Zoning District 1�' �� <br /> Field Checked Date Inspeeted IVewlReptar� <br />