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, . �p „/ D /0�7 �:�°�_�vE� <br /> , . vY,� <br /> - - � O J.�. � �;:': ;' � ?n 14 <br /> /�o,r, , o� <br /> � C.1TY C��= C�RON��;.��::. ���►�o <br /> ,.; �` ,� � Str�et At3tlrexs: i 11Ra���Rg Addruss: 7g(e�phone(952�I 2Q9-riGQO <br /> \%, ��/ 2754 Kelley Parkway i P.p_Bax bb Fax (952)249-461b <br /> �,�� `Rt. ; Oronu N'N 55354 Crystal Bay, MN 55323 www.ci.�.vnv.rrrr�.u5 <br /> �,til{�- r <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: ��=L�� �l��-�3�w:J Email: <br /> Mailin Address: �j� �� ��,r�`��,�.�,:� � • v►"�%'r�c< <br /> Phone: Cell:'3)�✓ �`'��� -��'` �work: `�= ;,..-r Home: <br /> �� <br /> Desi ner: v.� �i'��'`r� License# �jl� Email: ; Z- ''�`�(��1' Phone: T��'��'�':�"� � <br /> Installer/Contractor.�rq= .��, ��''�License#�-4:��"��mail: Phone:)ba �?�--%7� ' <br /> Date to be Installed: ' '� � �o/�- � 85- S <br /> Pro Address: �� �'� �--i^:�'�--> {-�`�-=t �!t- , U�.::i-:� <br /> Existin Se tic S stem E es: Yes� No Com liance Ins ction Date: �,�i �� � r,¢�: <br /> Parcel:(r�no address) <br /> �� <br /> L� �' :,��.� <br /> General Lot Dimensions: Width: De th: Total Area: (Acres or sQ tt) <br /> Home T e: � � � #of Bedrooms: S Clothes Washer: x Water Cond: �' <br /> Garba e Dis sal: � Hot Tub/Whir I: Dishwasher: <br /> Well:- E�� New to be instaHed Size of Casin : ���De th of Casin : <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: j�e:►i^��'w� Sizing Factor: ►,, 2� , <br /> Septic: New Replacement_�� Addition Other <br /> Tanks: Qty: _ ew Existing Total 3� <br /> Tank Type c-.�„�.:.�¢�- Capacity 2-�3::� Manufacturer �k�,.,,;,� <br /> Pump Station: Tank Type Capacity i 3�:.� Manufacturer 'UrT,��L%�z^ � <br /> (if applicable) Pump Size '/, A�: Type �����,:J F'���`� Failure Alarm Type �2��t.�l�* � <br /> Drainfield Total Length Total Width Maximum Depth �, <br /> Trenches w/rock Trench w//chambers � <br /> Rock below pipe �" in K <br /> U. <br /> Pressure Bed Mound � Other(explain) � <br /> Mound Dimensions: Rock Bed i� x 6� ft Absorption Area 7,c; x b 3 ft � <br /> Clean Fill below rock bed "�inches,/r; g�'%-�°-- 3;� �c �:%" <br /> Filter: Type Manufacfurer -- Alarm Type: -- <br /> New designs shall adhere to 2008 MPCA standards. <br /> OFFICE USE ONLY <br /> Permit# •`? �/U ��' ��� Payment Rec'd Zoning District <br /> Field Checked o 1. Date Inspected New/Replace <br />