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r 4b�, q _ `mil <br />City of SEPTIC TANK <br />AND DRAINFIELD <br />Elk" River PERMIT APPLICATION <br />PERMIT NO. i_ 4 <br />Date /4 1 // 1 L <br />site Address 'ZIS_V Vlkl.Z6 lycvn . SuitefUnit No. <br />Tenant/Building Name Condominium No. <br />The Applicant is ❑ Owne Q "Contractor ❑System Designer <br />Property Name <br />Owner Address <br />City 6c,< AJ10 4StateZip Code sic^ Phone `21Y1- d 1-/ <br />Contractor Name kY ice G k� 4 LJ47�-/;- & <br />Address A �� r � � �� License # 7 T <br />City 1_2� L-F State i {,41 Zip Code Phone 2 6� 5 <br />System Name _4q41_ Y44-✓ k 0--t,/24i?-4C1/"'L o?0 <br />Designer Address �/lc & � lst� License # <br />City L' A2u-ire- State A±f1, • Zip Codes Phone I <br />Class of Work ❑ I New ❑ 2 Addition ❑ 3 Alteration/ ❑ Maintenance/Repair/ 1 �' <br />Remodel Replace <br />Type of 01 Single Family Residential ❑45 Recreational, Amusement <br />Structure 002 Single Family Connected to Single Family 046 Other Nonhousekeeping Shelter <br />f <br />003 Residential Garage 065 Industrial Buildings <br />❑30 Two Family Residential ❑70 Public Works and Utilities Building""" <br />031 Three -Four Family Residential 080 Public Schools <br />❑32 Multiple -Family Residential ❑81 Private Schools <br />040 Offices, Banks, Professional ❑85 Churches and Religious Buildings f <br />❑41 Stores, Restaurants, Warehouse ❑88 Hospitals and Institutional Buildings <br />042 Hotels, Motels ❑93 Other Non -Residential Building <br />❑43 Parking Garage 095 Fences, Signs, Antennas <br />❑44 Service Stations and Repair Garage 096 Other Non -Building Structures <br />PLEASE COMPLETE OTHER, SIDE <br />13065 Orono Parkway - P.O. Box 490 - Elk River, MN 55330 - TDD & Phone: (612) 441-7420 - Fax: (6I2) 441-7425 <br />