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Cit of Or6(6,no FOR CITY USE ONLY <br /> /1*. <br /> ���� PO.Box �/ <br /> 9 <br /> _ �G,,/ /_ <br /> l 2750 Kelley Parkway Date Received: //-- / S ' <br /> --„Ni <br /> � ^,' Crystal Bay,MN 55323 Permit# CA CD/ 5F�" 4�oZ�7 <br /> Phone:(952)249-4600udy <br /> 'n <br /> `,i�eslioa ` Fax: (952)249-4616 l O l ( 1r Approved By: <br /> Amount$: yet:9- .o <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 SiteI er t r ona <br /> Site Address: y� U l/li',/,e_e"u.,J WA, '-A, 6til, <br /> Owner: ae/IZ,, -e--rz� Mailing Address: ,�J � , <br /> City: (�;1 r724) 1 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor l` ' n information: <br /> Contractor/App: 2c., /4 ,,,Z,,j_,,,e7.7 Contact Person: .i. 27 <br /> Address: 1c)/ / ' /L - g,I,i_, State License #:;'� <br /> City: —G �(4'nz� Zip: 6.--i- 3 a r Expiration Date: <br /> Phone:! 3 `7 7, - 0? /off 0 Alternate Phone: 4(Z-" Z 6 2 7,5 9 <br /> AIResidential Commercial I I Other <br /> **I ANT, ON AR LJ At T*�` <br /> Fill in all appr,„,_*,,,,,,.*LTO,., <br /> p i`iate'btan S and ctiec4k� ppi ti►priatii xes. <br /> Tanks: <br /> Precast Concrete _ Fiberglass 1 I Plastic I I Other: <br /> Number of Tanks: c <br /> Size of Tanks: / �h / _`Cc c <br /> Type of Activity: <br /> n Trenches if Mound Pressure Bed n 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 />