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� � City of Orono FOR cITY USE oNLY <br /> � N� `, P P.O.Box 66 --1 `� <br /> I 2750 Kelley Parkway Date Received: 7'� /�� / <br /> � ` Crystal Bay,MN 55323 Pertnit# � �-� � � <br /> �;�i�,,��,^\ ' Phone:(952)249�600 � <br /> `�' .`y Fax: (952)249�616 �' Approved By: <br /> ...-Kt�"`tlp,: <br /> � �i��'� Amount$: — — <br /> �� ���� <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: :13 5 S P^ ..-�� �; i� R� m�"�'�� J <br /> Owner: �Cb-��^7 �=� F1 e � t-o �i Mailing Address: iy -3� ��f�� n� h��� rc+ <br /> City: �d' � ►'1 � Zip: <br /> Home Phone: (v �� �9 i y �.�s Alternate Phone: �S� �.3,y �'�i � <br /> Contractor/Applicant Information: <br /> Contractor/App: 1�3�' �;.� Is��� �� Contact Person: �7 ,� t � � =J✓ � ��� � "�'� �`` <br /> Address: ) � ?'`�� �3 ��/ S'� ��''J State License #: -Z� / a <br /> City: r�T ��►c..�., Zip: Expiration Date: � � / � <br /> Phone: �� 3 4-�� "�� yd� Alternate Phone: ?s�:�' ��`� s��'� <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other___ <br /> *"ATTENTION APPLICANT�"" <br /> Fill in all a ro riate blanks and check all a ro riate boxes. <br /> Tanks: <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: 3 � 1 a, �� � <br /> Size of Tanks: 3�o �% `� ��,�� y�����ru� <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. <br /> Page 1 <br />