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t , � , _ aoi5�� ao8 z7 <br /> s-� -�� ,�S ����r�,�� <br /> %��� �°N ��`, ��� ° ����� <br /> �� � � ITY OF QRON�n'oFo <br /> � � � �treet A�]�Irris: , hlailirry ACIdre55. Tele��honc(y57 �-1�i�1b1`�,! ��� <br /> � � �,� >/�OKelle}� Park ��y w0 Fioxb6 Fax (957, '49-4n�� <br /> , <br /> � � �,�� _, � y -7_', c ' , tti Lza� (4'IP�� � .'_ � ���r. � sir _ <br /> `-��F$����1)��' � <br /> Septic System Permit A plication <br /> Please complete this applicaton completely. Failure to II in all of the required information may <br /> result in a delay of processing your application. Submit his application, a complete copy of the <br /> site evaluation and the design at least 3 working days rior to the projected installation date. <br /> , <br /> Pro ert Owner: � � � �9a. �r�.�..5 Email: <br /> Mailin Address: <br /> Phone: ����"'�ell: {��Z� ���" y���(Nork: Home: <br /> Desi ner: I�y 7 ��iJ� License # `��0 Emai : Phone: 7�j �t �—. 7 7 y <br /> Installer/Contractor: � �� ��5�+��icense #LL���Emai : Phone: �c�� �y �S - 7� � <br /> Date to be Installed: 5r'�(� <br /> Pro ert Address S �,. � ' � <br /> Existin Se tic S stem E es: Yes No Com liance Ins ection Date: <br /> ParCel: (if no address) <br /> General Lot Dimensions: Width: De th: Total Area: (,4cres or sq tt) <br /> Home T e: � #of Bedrooms: ✓ lothes Washer: �Water Cond: <br /> Garba e Dis osal: Hot Tub/Whir ool: ✓ Dishwasher: <br /> c <br /> Well: Existin ✓ New (to be installed) Size of asin : De th of Casin : ����,,�C�'' <br /> �C� `� <br /> 2,.� 3 , � ,��� ;;r <br /> PROPOSED SEPTIC INF RMATION •- �� � ��f� <br /> Soil Types: � �..��n� Si ing Factor: .� � C� <br /> Septic: ew �' Replacement A dition Other <br /> Tanks: Qty:�7j New Existing Total ,�� <br /> Tank Type :.a�.cv�� Capacity 13�� �^ Manufacturer �,,4r�.;; ►-- <br /> Pump Station: Tank Typecy'*��,ic Capacity i3o�� Manufacturer 7;4-vw; ,.. <br /> (if applicable) Pump Size 2 :.e_ rzType .N�Y� Failure Alarm Type <br /> Drainfield Total Length Total Width Maximum Depth <br /> Trenches w/rock Tr nch w//chambers <br /> Rock below pipe 9 n <br /> Pressure Bed Mound Other (explain) <br /> Mound Dimensions: Rock Bed i o x 6� ft Absorption Area -G>3 x � ft <br /> Clean Fill below rock bed z y r' inches <br /> Filter: Type�hr��_ Manufacturer�'r� ,�r Alarm Type: � .�-�e��.� <br /> New designs shall adhere to 2008 MPCA sta dards. <br /> OFFICE USE ONLY <br /> Permit# �G l'�� QG�S27 Payment Rec'd � � / Zoning District <br /> Field Checked Date Inspected New/Replace <br />