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, �. <br /> �NO P P.00BoxO66 n0 RECEIVED FUR GTY USE ONLY <br /> 2750 Kelley Parkway i�I p ry i 7 Date Received: �� / � <br /> Crystal Bay, MN 55323 �UIV 2 U L�I 1 <br /> z� �� Phone:(952)249-4600 Permit# 1 �— �70� <br /> ��kasHoa� Fax: (952)249-4616 Approved By: <br /> CITY OF ORONO Amount$: <br /> /' CITY OF ORONO —SEPTIC SYSTEM PERMIT APPLICATION <br /> p �`�\� (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> �����#�.f C��vi���-l�fcarrx��#iQn; � <br /> � . ^ l - <br /> Site Address: °���' v� l � Vl L/�'s� � �u (Z-� <br /> Owner: ( c� u i��y..e c� Yvl L,=S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Gt�tr��pr/;��ii�rlt`1���t���� -�,. <br /> . V=-�-� <br /> Contractor/App:. �� �� d-�� t Contact Person: <br /> Address: 2�� � �i-- S�� State License #: � � (� <br /> City: _�'1�-n,�-�-��_.__ Zip: S�3� '� Expiration Date: _ Z� � � <br /> Phone: C� ( � � � `1 e� i l Alternate Phone: <br /> x���� � s����= �S flF flCCi1PAN�''if ��,� �; ,��;; <br /> esidential ❑ Commercial ❑ Other <br /> � : **ATTENTIOtV APPUCANT** _ . <br /> , ,, t <br /> Fi11 in a!� a _ ro riate blanks ar�t� check a�l a ro r�ate boxes. � <br /> Tanks: <br /> �recast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: ��a ��, <br /> Size of Tanks: Z 2 S� G✓Yw� � ���� �� �`� <br /> Type of Activity: <br /> ❑ Trenches Mound ❑ Pressure Bed ❑ Chambers ❑ Holding Tanks <br /> ❑ Pre-Treatment ❑ Other <br /> NOTE: Provide an As-Built of the system before the final inspection. <br /> A 24-HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. <br /> Page 1 <br />