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City of Orono FOR CI Y USE NLY <br /> �NO P P.O.Box 66 / <br /> 2750 Kelley Parkway Date Received: G <br /> Crystal Bay MN 55323 Permit# / G <br /> Phone:(952)249-4600��Cd <br /> SHO Q'E Fax: (952)249-4616 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 /> IIVtl 0 � ���i P ;&z Yalu +:9 <br /> Site Address: / JV j rn`�c1�cJ cl <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: _12-0 7w/ '7 ze, <br /> Contractor/App: Ve flGrtih'f1qL 1,,,-c Contact Person: <br /> Address: /aU rn S State License#: � <br /> City: Zip: 5 j Expiration Date: 90/fir <br /> Phone: Z 1/k 6 7 Alternate Phone: <br /> TYPES,OF C3GC <br /> Residential ❑ Commercial ❑ Other <br /> ON APPILICAItiT <br /> Fill in Alj.aRpropriiate blanks and check all appropriate bosses. <br /> Tanks: <br /> M Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: <br /> Size of Tanks: <br /> Type of Activity: <br /> ❑ Trenches A 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 />