Laserfiche WebLink
�� - . <br /> : � <br /> ' �-- %�/'��IS� �c��, d �,����dtcli�Nr �;�1�tI� 1,��� �c'c�>i�lC r�r.�-t�.1/�'/�,..1 <br /> b� �Cfc`�/��' 1�, z �f��. <br /> ' p�" City of Orono ` ---"'� � Fott c�1'�r u5E oH�v <br /> �� � ���. P P.O.Box 66 � '1� <br /> tt `i 2750 Kelley Parkway Date Received: Ol <br /> �• f� Crystal Bay,MN 55323 Permit# d� <br /> � `' Phone:{952)249-4600 /�� � <br /> t�,,: <br /> `�kestio�-`�' Fax: (952)249-4616 c Approved By: <br /> _..____ � Amount$: � <br /> Ci��'`�� � <br /> 7L <br /> � CITY OF ORONO—SEPTIC SYSTEM PERMIT APPLICATIUN <br /> (All permits must be approved by the On-Site Septic Manager andlor Building Official) <br /> Job Site/ Owner Information; <br /> Site Address: �-- /CpC) �� t f� ��� /�'��`"-'�'-'-- <br /> Ov�(ner: � " - <br /> �F L'f�'? .>C�j�°/'�r`'� Mailing Address: <br /> City: �%/'c� r� Zip: 5 � �S� <br /> Home Phone: c J`�-�- �.�t% �% 7 7 y Alternate Phone: <br /> � <br /> Contractor T Applicant Inf4rmation: <br /> Contractor/App: �`�i17��C/L �%��-.ht�i� �n�,Contact Person: ��(' �`��i ���� <br /> � Address: ���z// L-��i�c`�f��" }�r' i11�-- State License #: L- �� �c�� <br /> City: 'U�7`� /'l�r'L'/Y/t�l�ip: 5� ��� Expiration Date: G� , � � -��' <br /> Phone: � � z-- `�/ r! ��//Z-- Alternate Phone: <br /> --�_�___ <br /> TYRES OF OCCUPANCY ' <br /> Residential ❑ Commercial ❑ Other <br /> **ATTENTIeJ►N APPLICANT ** <br /> Fill in al[ appropriate blanks and check all appropriate boxes.____���_� <br /> Tanks• <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Nu ber of Tanks: `, � <br /> Size of Tanks: �e�C�C�� 10�`>�� f���� <br /> Type of Activit : <br /> ❑ Trenches Mound ❑ Pressure Bed ❑ Ghambers ❑ Holding Tanks <br /> ❑ Pre-Treatment ❑ Other <br /> NOTE: Provide an As-Built of the system before the final inspection. <br /> A 24-HDUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. <br /> Page 9 <br /> �_ <br />