520 Lone Oak Rd - Septic System Replacement 2020-09-01Eagan Permit #EA166684
APPLICATION FOR SEPTIC PERMIT
InzPactron, Inc. Permit #
g6120 ChIppendrale Ave, Suite 104
Rosemount, MN 85068 Date Recdvod:� _-
Phone: 661-j322-6626 or 800-322.6153
Fax: 051-322-76802
Please prinf all Informatlon—
Property Owner Name:-tkabw
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(L/(Last Namo, First Name)
Address; Td" (tomo 06k _�_ �v�• (Street or Box, Glty, State, Zip Code)-- -
Site Addre
Inatalle
0#1-0
Township:, Hetjot':' Property Ide itifloatlon Numbsr(PIN)//%--
COPY OF ,91TE EVALUATION ANG] SYSTEM DESIGN MUST ISE ATTACHED
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SYSTEM INFORMA'TIOM
Bu11dl e
Resldentlel
Non -Residential
Type of lMprovemnnt
New Syatam
epiaeement System
Alteration or Repair of Existing System
❑Abandonment
El Tank Replacement Only
System TyP.R
nChl{ZGGII
TrenchlChember
_ Preaeure 13ede
Mound
At Grade
Trenchlr--Z Flow
� elepnone
TelophRna
t'TT--y--P:'t
S I uype 11 Molding Tank
❑Typa III Chamber or562 Pipe
1]Type W Advanood
❑Type V i'ermorrnance
9;73
tensa tF�
I
Rid1dinu infonTratlon
7 Number of Bedrooms
gollds
uture 5edrooms
GrinciDdElsmt
arbago Disposal
TDishwmiher
/4qu Systam Gallons porday
Number of hlew Tanks Installed
Number of Eitlsting Tanits
Total Number of Tanks
REQUIRED SE'TBAC$CS—Checkall that apply
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--- Drarnrle�
Property Llnos
ATO Feat
,8'I0 Feet
Occupied Building
g.?3U Feet
010 Feet
Recreation Lake or Trlbutzry Creek
075 Foet
p7fi Feet
AN Other Shorelands
01 SO l=oot
0150 Feet
Burled Pressure Distribution Water Pipes
❑'10 Feet
010 Feet
Well (60 + of casting or 10' of impervious material)
,Pjn Feet
Wd Feet
Weil (not meeting above specifications)
0110 Feat
13100 Feat