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, � <br /> .-�o�o� <br /> ��� �S � <br /> `� C 1TY OF C�RONO <br /> ,�, Street Address: ' Mailing Address: Telephvne(452}249-4600 <br /> y�, � ?750 KellPy Parkway � P.O Eiax 66 Fax !952`?49-d61h <br /> ! ` . . , . , <br /> � °' <br /> �kf�s�io� , �. , .. _ _ <br /> Septic System Permit Application <br /> Please complete this applicaton completely. Failure to fill in all of the required information may <br /> resutt 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 /> Site Address: <br /> 1 Z�C �r�k��l� Gv��� �� �►�r�� �,'r�C m��,� SS�� � <br /> Owner Name: C�Y.��'� �1 � -�f'' Address: (z�C� F}''���C�� C����t-lc_ �6�1,�`�- <br /> Owner Home Phone: �'�2.-�7 S - (�S Work Phone: (U -;� -(�{/ <br /> Desi ner: S(' �T���fii ` � License# ���� �j� <br /> Desi ner Address: �S � Cc`�' 1� c-� Lc=�i�-� �'�� Sf,/L��C f� .� " n''�, ) �j 3�7 � <br /> EmaiL �" �,� i ►�Yv��►''S wc1 Stc Wc�t-r-.r� �ti`�v�Phone: �(r% �3� `f�% �7- ;3�� �-(r� <br /> Installer/Contractor. `'l i� ��c_ ���.�e�n�a� License# <br /> Installer Address Date to be Installed: <br /> Install Email: Phone: <br /> Existin Se tic S stem E es: Yes nro Com liance Ins ection Date: <br /> General Lot Dimensions: w;drn: oe�,rn: Total Area: �acres orsq n�� �7 S�`7 �� <br /> Home T e: Si�c� Fc�,�� L #of Bedrooms `j^ <br /> as�r Water Softener Garba e Dis osal � Hot Tu hir! ol� Di washer � <br /> Well Exisrin rvew (to be installed) Size of Casin : De th of Casin : <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: ,� i� 1,� Sizing Factor: <br /> Septic: N Repla ment Addition Other <br /> Tanks: Qty: . New Existing Total _�,����� C=?cL1 l��S <br /> Tank Type � � Capacity T(� Manufacturer <br /> Pump Station: Tank Type rv Capacity l�1 A Manufacturer <br /> (if applicable) Pump Size Type Failure Alarm Type <br /> Drainfield Total Length Total Width Maximum Depth <br /> Trenches w/rock Trench w//chambers <br /> Rock below pipe inches <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 /> ('eC�, � � °2_ �� <br /> OFFICE USE ONLY <br /> Permit# Z�! S~D�) 1 � � Payment Rec'd Zoning District <br /> Field Checked Date Inspected New/Replace <br />