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City of OrOno FOR CITY USE ONLY <br /> �NO P P.O.Box 66 � <br /> 2750 Kelley Parkway Date Received: �:U�/ / <br /> y � Crystal Bay,MN 55323 Permii# O�Q� 7- `O..j "J <br /> c �. Phone:(952)249-4600 <br /> ��KFSHOR� Fax: (952)249-4616 Approved By: �o <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 /> �� ������Q� <br /> 1 �f) <br /> Site Address: � � �� r. I �'� ��`'`� ! " � <br /> Owner: �� � ,�f'`� �K.�,� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> �onfractor!��1i�ant ln'f���#i�3 ; <br /> A / . <br /> Contractor/App: � - - �C1 Sl/L�S Contact Person: ���'P--� <br /> Address: Z� �� �2 `=� �-�� S �S State License #: �--Cv �(� <br /> City: �-z-c � Zip: �'-S'�� �t Expiration Date: L�e�- • Z�i `� <br /> Phone: (� z � ��`� �'j 5��� Alternate Phone: <br /> ;� ��`�;�, k ,� � � <br /> �Residential ❑ Commercial ❑ Other <br /> . . � - , . �* �TTEN7'1�J�1/#�PPUCA��`* <br /> � - :� <br /> ; .; . <br /> � - = fill in a�! a ro riate blanks antl check a!1 a ro riate �oxes. ` � <br /> Tanks: <br /> �] Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: � <br /> Size of Tanks: ,� 3 U 1) � � c�t� � S'�J <br /> Type of Activity: r <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. <br /> Page 1 <br />