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City of Orono FOR CITY USE ONLY <br /> O P P.O.Box 66 <br /> 2750 Kelley Parkway Date Received: E�5 <br /> i Crystal Bay,MN 55323Permit# i b C,c` <br /> F . <br /> Phone:(952)249-4600 <br /> �KtSROak Fax: (952)249-4616 Approved By: x"i!!�j <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 /> Site Address: `� l�/� I tom r <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App: _Mae,- Contact Person: �;� (\ ei <br /> Address: 7 7t G State License #: 1 36,)_ <br /> City: _rncu��/ Zip: Expiration Date: ��- <br /> r <br /> Phone: Alternate Phone: <br /> XResidential ❑ Commercial ❑ Other <br /> WPUeVNT <br /> Fill in all roriate blanks and check ali appro #e boxQs. <br /> Tanks: <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: 3 <br /> Size of Tanks: __'4.'500 1500 <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 />