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� � City of Orono FOR CITY USE ONLY <br /> �/ � N��`, P P.O.Box 66 <br /> ` 2750 Kelley Parkway Date Received:/U i 7 -�� <br /> �� Crystal Bay,MN 55323 Permit# .��/7 —v/J���7 <br /> : Phone:(952)249-4600 <br /> ��''���,,,��w`,��� Fax: (952)249-4616 APproved By: <br /> Amount$: <br /> CG�� �.,� t ���Cv�a�.��� <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> � Job Site / Owner Information: <br /> Site Address: __� ) (v � J L`���'V�f,t,,,fv�..,� .��'y`I v � <br /> , � <br /> Owner: ��l 1 ('�l�i�',� ������1 �.��'�^;_i��L�.►,� Mailing Address: ;��� ��y ti,�l,!��c:� � � j��_.�, �j <br /> �;;; <br /> c�ty: d�� �,�� ;%��r c�l� � z�p: `-�`_� �r � `��► <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/A ��J � ����v �y_L } i �( , <br /> pp: �C{ � �� c� . Contact Person: +�A e� Q� � �' <br /> Address: ) � ��G Z Gt. �`v� fi-�;t�- J�'L l�l��_ State License #: L 7 U � <br /> C it . 1'-►�b V .-_ _, <br /> y� Q,✓ Zip: � S �y � Expiration Date: ��- �� - ' ` 't �, <br /> �_ <br /> Phone: �l�� => �E ? �1 `��r� C ����_ �� Alternate Phone: ��� � ��� �� `��1� ► l�� <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> **ATTENTION APPLICANT ** —i <br /> ; Fill in all appropriate blanks and check all appropriate boxes. � <br /> Tanks: <br /> 0 Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: 1 <br /> r <br /> SizeofTanks: � ,j �? ��5�"U <�>� ���'r< < �9�.�,,��t_ i i �:r��� ����.�('. �i<<„��_l��rv- <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. ��(�����p <br /> ��� � /��o�� <br /> Page 1 <br /> ��������� <br />