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1 - + <br /> �p� Clty Of OI'OIlO FOR CITY USE ONLY <br /> O P P.O.Box 66 <br /> 2750 Kelley Parkway Date Received: <br /> � Crystal Bay,MN 55323 <br /> z�* �. Phone:(952)249-4600 Permit# <br /> �'�ktsnoa� Fax: (952)249-4616 Apptoved By: <br /> Amount$: <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 /> ,�� ;�it�.l O�m��'lr�forn���r�: <br /> Site Address: __ " >:.t' �,v��9v;y JZ�� �,, <br /> Owner: ('•�r�ai�.�i" (;��,,J �,� t�-�2 Mailing Address: ���;�� C.i�� r2��• �.� <br /> City: (�,i,2� ��:� Zip: � ��3 S�(�> <br /> Home Phone: �C`� --�S ��� � `5 l� � Alternate Phone: <br /> �t�tr��#�r 1��ilic:�+�t i <br /> Contractor/A �- � -���,r�N'L '� <br /> PP� tz Contact Person: �; <br /> Address: ��I'�3v �7� �v:� �"� State License #: _ P►�1 C�J� ►� � ' <br /> C�tY= ��`��^�`� `�'� Zip: SSZ-I �1 � Expiration Date: 1 Z� �i <br /> Phone: ��-Z lo�1 2 �G�� �—,--� \�t <br /> Alternate rhone: 7k��• 2 i�: r � Z-\� fv <br /> ` � �S 13F �CCUPANC'�t' , ���`�, ' �. ;� <br /> � �s � .,� - <br /> . .. . <br /> ..� �, <br /> �Residential ❑ Commercial ❑ Other <br /> � ** ATT�NTtON APPLICANT ** �', <br /> , Eiii in al! � ro riat� bl��nks ant� check all a ��ro r�ate boxes: _ ' �_ _� `�` <br /> Tanks: <br /> �'Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: � <br /> � <br /> Size of Tanks: ' <br /> Type of Activity: <br /> 'Trenches ❑ Mound ❑ Pressure Bed ❑ Chambers ❑ Holding Tanks <br /> �; <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 />