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City <br /> ANO P P of <br /> O66 no RECEIVED FOR CITY USE ONLY <br /> 2750 Kelley Parkway Date Received: <br /> Crystal Bay,MN 55323 AUG 14 2017 <br /> s # <br /> Phone:(952)249-4600 Permit <br /> ,le SROFax: (952)249-4616 CITY OF ORONO Approved y <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: ou" <br /> Owner: Mailing Address: <br /> City: (arc by Zip: 35(, <br /> Home Phone: Alternate Phone: <br /> Contractor/App: �� 1�vA- L 1 Contact Person: C/ <br /> Address: f tb CZ1, 1 �,„ ` State License#: <br /> City: V�l�h'1/7 Zip: S3 Expiration Date: <br /> Phone: 5j Alternate Phone: Ge-ik *56 1 <br /> Residential ❑ Commercial ❑ Other <br /> APPLICANT " <br /> .and check all appropria#e boxy , : :--,. <br /> Tanks: <br /> fiffPrecast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: <br /> Size of Tanks: SCJ 13G <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 />