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�pN City of Orono FOR CITY USE ONLY <br /> � P P.O. Box 66 <br /> 2750 Kelley Parkway � Date Received:___ _1�Z��li 1 ��G' <br /> �� Crystal Bay,MN 55323 � ' Permit# ����(C"— �r;� 1 I� <br /> Phone:(952)249-4600 ^ r� I <br /> �''Ar��`�` Fax: (952)249-4616 ' II�` `� Approved 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 /> Job Site / Owner Information: <br /> Site Address: 3�g� Co��� P2o�c� C� �o � a ✓�'`l� .���s � <br /> Owner: ���K ►�-r�d���✓t � ���d �,n d Mailing Address: /Q 0 �Z�✓�,dr� �J <br /> c�ty: ��o ,�►�C� n s.Tr�, �/ z�p: �S��� 3 <br /> Home Phone: ��1 �-- � 17 `��� Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App: S2 /��"(`L �-��G� Contact Person: ��GJ+ S U o� �-�a"� <br /> Address: (9 U� '� �e�S}a�� j� a�� State License #: a� �� <br /> City: �M ;( G � c� w� �/ z�p: �6 3 S 3 Expiration Date: a' � � �--v � <br /> Phone: �20 (2eZ o N�-.5—.� Alternate Phone: <br /> TYPES OF OCCUPANCY l� y��c <br /> T � T��G <br /> �esidential ❑ Commercial ❑ OthE < <br /> , C7NL�j <br /> ** ATTENTION APPLICANT ** ,'-� <br /> Fill in all a ro riate blanks and check all a r`rna l <br /> Tanks: <br /> �Precast Concrete ❑ Fiberglass ❑ Plastic ❑ --�� �` <br /> Number of Tanks: _-�-- -_-�-�� =-� <br /> Size of Tanks: I.S� ° �ti I� on <br /> Type of Activity: <br /> ❑ Trenches ❑ Mound ❑ Pressure Bed ❑ Chambe,� ,�,� ���U���y �anres <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 INSPEC�IONS. <br /> / <br /> Page 1 <br />