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RECEIVED <br /> ,'��101�l�` City of Orono FOR CfTY USE ONLY <br /> O `: 2 50 Keley Parkway � ��!U Date Received: / �� �� <br /> ' ��V 1 <br /> `�,�� � �� Crystal Bay,MN 55323 Permit# oZ C�� �c� � � <br /> Phone:(952)249-4600 <br /> ��'��.`?xf`�;,��".���� Fax: (952)249-4616 �+����QR�NQ APProved By: � <br /> �J �� . Amount$: I��i � <br /> \", / <br /> l�� CI7Y OF OROND- SEPTIC SYSTEM PERMIT APPI.lCATlON <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official� <br /> Job Site / 4wner fnformafion: <br /> � .� � ���� <br /> Site Address: .�-7.3C� �4� ���'��'�c c� ��/���5 f-/,e ir��E�,7 �?r��: � r', ' ���irc� ��i <br /> �C.e. ,�j �?c�i�C=. <br /> Owner: �ir h C�'I��� ;l/' �. Mailing Address: �;7�� ;�,�„��� t�,,�,� �,� <br /> y. ,:t�ne �t�/-�r th�, <br /> Cit ��'/�c'nU� Zip: <br /> c c��.i�� . <br /> ;; <br /> Home Phone: Alternate Phone: ����� �3��� �7��C%` <br /> �,cl,�� ,� ��11J�J���.:, ��� <br /> Contractor 1 Appiicant lnformation: <br /> ? <br /> ContractoriApp:� l-�c�f�-���t- �i''v�ht'/�•� �?����. Gontact Person: ��ic�c-��'i�� ����r��-!�r� <br /> A�dress: � �V/ �«�n`��'� ��l�c' r2��- State License#: L- �;5'�/�� <br /> City: �?}� �'Y1��I�c� �Zip: 5 5:� 7Cr Expiration Date: �-; � � 7 � �-���"`7 <br /> Phone: � � �- I� t G �t�---� Altemate Phone: <br /> �____. --- -- _____ <br /> . TYPES OF OCCUPANCY <br /> �µ <br /> �'`esidential ❑ Commercial ❑ Other <br /> i` <br /> -- --- - <br /> **ATTENTIO�! APF�LICANT�* I <br /> , <br /> �__ Fiit in all appropriate blanks and check al@ appro:;3r��te baxes. � <br /> Tanks: <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: `� <br /> S9ze of Tanks: f��;G ��;�..)h�C., l�t' ��e�i�—� /z2'"-�"��f 1�� <br /> 7— <br /> T_ype of Activity: <br /> ❑ Trenches ❑ Mound ❑ !'ressure Bed ❑ Chambers ❑ Holding T�nks <br /> ❑ Pre-Treatment ❑ (ather ��r►k. /'P�'f�����r��n� <br /> NtJTE: Provide an As-Built of the system before the fina! inspection. <br /> A 24-HOUR NOTICE IS REQUIRED FOR AL� iNSPECT10A1S. <br /> Page 1 <br /> r <br />