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. , <br /> r--- FOR CITY USE ONLY _. <br /> „..,,\WAt Citypp008f0Ox 6rO6 no 1 <br /> * S-^/5-11■0 <br /> 2750 Kelley Parkway Date Received <br /> Crystal Bay.MN 55323 I Permit# Cge7/iv '"01,9406,A.,) <br /> 1 Ar,\ -.." Phone'k952)249-4600 , <br /> 1 <br /> Fax (952)249-4616 , Approved By: , I <br /> Articiunt$ yDe. A) <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: 2 7 7 S L 14 i E Co_ tc (1,4,ye I em <br /> Owner: - v\t‘, t a v 0 il Mailing Address: 277 S I,1)1,t k l)(11 .0 { <br /> City: 6 V"(.. 11 C, Zip: `-')- S-- 3(..;(,., <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Informationd <br /> , , <br /> Contractor/App: c .)' ) ‘..).i-tv,i)o.,(4 co ( JL Contact Person: ,,,i Y1A, S4 1/tick. .-- <br /> Address: I I D 3(.,', 1---CIA,N 1 O 0 1-- tql, Alc State License#: L 7ö_?) <br /> City: i 16',0 tie ti" Zip: i'V t,i Expiration Date: 1 /311Z,(D153 <br /> Phone: -7 L Lt.e.LI CiC3 C) Alternate Phone: (0(L 36762 e.,,eq I <br /> TYPES OF OCCUPANCY <br /> X. Residential I Commercial 1 Other <br /> **ATTENTION APPLICANT** <br /> Fill in all appropriate blanks and check all appropriate boxes. <br /> Tanks: <br /> Precast Concrete PI Fiberglass P Plastic n Other: <br /> Number of Tanks: (1) l 1`-;(..) '->e pi-1 L (1 ) )otc, pup * e itekt,& ' - <br /> Size of Tanks: ,----77 <br /> Type of Activity: <br /> 7 Trenches )( Mound I Pressure Bed [7 Chambers E Holding Tanks <br /> LJ 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 />