Laserfiche WebLink
� . ,,.�L L,• �o�D.� � <br /> ���vL��-, 020/�!-O/I��l�' <br /> ,f� ���C� � � <br /> � t��T� oF ��oNo <br /> � „ �' � � Str�et Ac�drass: M1Railing Adcfruss; Tittt�phsnea(952)249-�I600 <br /> ' ��� �/ 2754 Ke�liey Parkwa}+ , P.O_Box 66 Fax (95�249-46�6 <br /> �q 2��' ' O��nu IVN 55356 Cryst��8ay. M14N 55323 ww�v.��.cronv.rn,,.u� <br /> 'fL.511�ti♦ <br /> Septic System Permit Appiication <br /> Please complete this applicaton comptetety. 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 evatuation and the design at least 3 working days prior to the projected installation date. <br /> Pro Owner: � �„ Email: <br /> Mailin Address: _...____-.------___--� _, ,,�.. (� (2 �_ � � <br /> Phone: Cell: � Work: Home: <br /> Desi ner: Z�S'f (� License#� C� Email: Phone: - � 9 �7� <br /> Installer/Contractor: .� License#� Email: Phone: �7(v 3•-C( -/`71,0� <br /> Date to be Installed: <br /> Pro e Address: / L Z,`r� i2E� �� <br /> Existin Se tic S stem E es: Yes No om liance Ins ction ��te: <br /> ParCel:(rf no address) <br /> �j�t� <br /> General Lot Dimensions: Width: a �res or sq�) <br /> Home T e: s/�� #of Bed, �� 1 Water Cond: <br /> Garba e Dis sal� Hot Tub/VVhir <br /> Well: Existin New t be installed �f Casin : <br /> PROPOSED S <br /> Soil Types: �-� yo►� _.,�y ractor. <br /> Septic: : New Replacement Addition Other <br /> Tanks: Qty:� New .� Existing Total 3 <br /> Tank Type Cn�-,�c�,4.� Capacity z-- i 3�v Manufacturer !s-�-��ti, <br /> Pump Station: Tank Type�r„c�£apacity 1 3 4�u Manufacturer �-�-�'���. � <br /> (if applicable) Pump Size J �•p� Type 3c �P�.. y� ,, Failure Alarm Type L��{/�,.,,,,� ��s <br /> Drainfield Total LengthT Total Width �� Maximum Depth � <br /> Trenches w/rock Trench w//chambers � <br /> Rock below pipe �' in v <br /> K <br /> Pressure Bed Mound ✓� Other(explain) � <br /> Mound Dimensions: Rock Bed �� x b� 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 ONLY <br /> Permit# �t�/�/ 'D� v �g Payment Rec'd Zoning District <br /> Field Checked Date Inspected New/Replace <br />