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� RECEIVE'� <br /> ,� ����- OCT 2 2 2014 <br /> �,,+C�.��� �°�.,1 �j ,� <br /> � '; C�✓ ���T� �F �RC���Y OF ORONO <br /> I�� � „ <br /> . . ��,.� v.�i& tt . €� �,t,. .�. .... .� >',lr.'e=i�m��i9 <br /> � � `w I� r1��<�Ce'�r i ir)t,a�. 4'�} �1C'a.€xc� J .� 47��,i �$:�-s�+`z'�3 <br /> �`�I� � �'-- �s<3:>S'd<?�, s J:e.::as ''�. .".,t�.,t.. ��s� !:��i�"a�J»:Sj-� �'��.. ra�aw,..:<c_.�<. ,.�.� <br /> �..,�>.. �{����'��`�`�r,.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 ert Owner: .{- iC L ' I Email: <br /> Mailin Address: �'J � �'! -- L �i � � ' I' i.t` • `"� � <br /> Phone: Cell: Work: Home: <br /> ��'�������'��� Phone: <br /> Desi ner: . L ' � License# �Z S Z, Email: :��u, � C i� �i� <br /> fyr-¢.l�`� �r"(�v L F�i3 u �v`"�- <br /> Installer/Contractor: -- License# � EmaiL��- a - PhoneL�� '- r�Z <br /> Date to be Installed: f�=/�� / <br /> Pro ert Address: � � � 2 :" L�-ih� � <br /> Existin Se tic S stem E es: Yes No Com liance Ins ection Date: <br /> P81'Cel: (if no address) � /�� — r G �� � F <br /> General Lot Dimensions: Width: De th: Total Area: (,4cres or sq rt) <br /> Home T e: #of Bedrooms ,j Clothes Washer: Water Cond: <br /> Garba e Dis osal: Hot Tub/Whir ool: Dishwasher: <br /> Well: Existin New (to be installed) Size of Casin : De th of Casin : <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: Sizing Factor: <br /> Septic: New�_ Replacement Addition Other <br /> Tanks: Qty: Z New�_ Existing Total Z . <br /> Tank Type 'i� �: Capacity /C�c? Manufacturer :�ivFi tTL�-iTl'}`�� <br /> Pump Stati n: Tank Type 1/�f, �L(___Capacity /aCC_'� Manufacturer i-%UfiL7i7 var�'�_ � <br /> T'-i- p'� <br /> (if applicable) Pump Size Type Failure Alarm Type � <br /> Drainfield Total Length Total Width Maximum Depth � <br /> Trenches w/rock Trench w//chambers v <br /> K <br /> Rock below pipe in v <br /> Pressure Bed Mound Other (explain) � <br /> Mound Dimensions: Rock Bed x ft Absorption Area x ft � <br /> Clean Fill below rock bed inches <br /> Filter: Type Manufacturer Alarm Type: <br /> New designs shall adhere to 2008 MPCA standards. <br /> OFFICE USE O LY <br /> Permit#d � —O`� •Z Payment Rec'd Zoning District <br /> Field Checked Date Inspected New/Replace <br />