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1-‘%..01\--i\ City of Orono A <br /> FOR CI USE ONLY <br /> O\ PPO.Box66 7� 1 _2750 Kelley ParkwayInDate Receiveda/�,� c� l <br /> yCrystal Bay,MN 55323 �Y Permit# vc�J 1 i / (Jr eik <br /> ____5,,,-. Phone:(952)249-4600 <br /> `445500 Fax (952)249-4616 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 /> Jobt#e leriii r#r#arm <br /> Site Address: / g 6 0 % (-A-1W r(2to s <br /> Owner: { 1.4rk to (i'i-4,-) Mailing Address: lk66 Gv, (Ci4.9.-1 /eel <br /> City: iesaf Dv'tiht,2 Zip: 53-3 <br /> Home Phone: Alternate Phone: <br /> Contractor/App: /7 7-e> i j. Contact Person: <br /> Address: 1C 3 5 f S r State License #: L 6 y o <br /> City: SI #z".tv+c Zip: 536'' Expiration Date: 7_Ul <br /> Phone: -6 (L 6 £ TS`2 Alternate Phone: <br /> 'LL Residential ❑ Commercial I I Other <br /> * 'IT Pil AP' ,IC s A <br /> Fill in all . • f.ro p rate blanks and eck all a, .tot a boxer 'Ts <br /> Tanks: <br /> Nfc Precast Concrete n Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: 3 <br /> Size of Tanks: /G/-=%Ci / e).C) jo' <br /> Type of Activity: <br /> ❑ Trenches Mound I I Pressure Bed n Chambers I I Holding Tanks <br /> ❑ Pre-Treatment n 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 />