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City of Orono FOR CITY USE ONLY <br /> �NO P P.O.Box 66 –�_ 7 <br /> 2750 Kelley Parkway `^' Date Received: <br /> s Crystal Bay MN 55323 <br /> -4600 Permit# — <br /> Phone:(952)249-4600 <br /> �'kFSHOQ'� Fax: (952)249-4616 �i� 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 /> Site Addres��s:// � �1C� l� ((�cr� ��, ,� fs <br /> Owner: /V0(__J0P_1" Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App: _ 1Z C. Contact Person: <br /> Address: 3710 Cc�a)y �l State License #: <br /> City: V '�, 1'k, Zip: 57 w Cl Expiration Date: <br /> Phone: Alternate Phone: <br /> CCUPAR-CY <br /> ❑ Residential ❑ Commercial ❑ Other <br /> Fill in all _appropriate blanks and check all annronrfate hcMc <br /> Tanks: <br /> ❑ Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: <br /> Size of Tanks: <br /> Type of Activity: <br /> ❑ TrenchesZZ. E] F-1E]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 />