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HomeMy WebLinkAbout2008 - P12205 - new septic system PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: P12205 Crystal Bay, Minnesota 55323 Permit Type: Septic (952) 249-4600 p Date Issued: 6/26/2008 SITE ADDRESS: 1990 West Farm Rd Unit# Long Lake,MN 55356 PID: 27-118-23-43-0022 DESCRIPTION: Proposed Use: Residential Permit Class: General Septic Permit Sub-type(s): New Septic System Permit Type: P DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: Must submit a monitoring plan. FEE SUMMARY: Permit Fee: $ 100.00 Valuation: $ 0.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 100.50 APPLICANT: Hayes&Sons Exc.Inc. OWNER: Aramand&Mary Brachman 263 82nd Street S.E. 1990 West Farm Rd Montrose,MN 55303 Long Lake MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. '/ 6:1-4(...icit APPS PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Required), I-Applicant, I-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 of Orono FOR'CITY'USE ONLY Box 66 2750 Kelley Parkway Date Received: eV Permit# / © Crystal Bay,MN 55323 t^E/ (952)249-4600 Amount: $ CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION (All permits must be approved by the On-Site Septic Manager and/or Building Official) Site Address: ( q _1 0 -'- cQ • Owner: A vv\4+,- Af\.) Mailing Address: Vic-10 - F4.-.v. City: U v - o Zip: Home Phone: Alternate Phone: ;.,2 i I 7( .? 3s,"( 5-moo Z_ '711, Contractor/App.: 14c.,./ .5 .t S e-' Contact Person: 6"12-.47 Address: 3 State License #: L C City: i'i'1,7,-‘. Zip: 5'x"3(-03 Expiration Date: "z.c>/f) Phone: ") 3 -- Lf 7 5- Alternate Phone: /2 '- 6 g3- — y5-S-CD Residential ❑ Commercial ❑ Other $� "�' "�; ..� ;. ,�� a , � 4 New or Replacement System $100.00 / lU Repair Existing System 50.00 (Tanks or Drainfield) State Surcharge .50 .50 Total $ / U v '-�=� V:\(Permits)\Septic System Permit Application.doc 1 / 2 `� a,,� ��� ��. I will be installing the following: Tanks Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other (list manufacturer) Number of Tanks: / pc•e^"i 144-`"- Size f4-`Size of Tanks: .er.s j / 4:20 hr /eel.) /0c0 i V'f Treatment System Trenches s.f. Mound s.f. i a 3 V- Gravel less s.f. Chamber s.f. Final Cover/ Top Soil to be borrowed from site (show location on site plan) L.- trucked in The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, agrees to do all the work in strict accordance with ordinances of the City and regulations of the State of Minnesota and certifies that all statements made on this application are complete, true and correct. Signature of Applicant Date: 6 - 2-5 —�� MPCA License No.: `f O Staff Review: [VAccept ❑ Denied Reviewer: 4/, }",e_„ Date: 6 6-- 034 Reason for Denial: Comments (to be printed on inspection card): V:\(Permits)\Septic System Permit Application.doc 2 / 2