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r <br /> �"�� � ���� Clty Of OPOIlO FOR CITY U E ONLY <br /> � � ����, P P.O.Box 66 <br /> `' 2750 Kelley Parkway Date Received� �� � <br /> �� ^ ! Crystal Bay,MN 55323 Permit# — 5 7 <br /> Phone:(952)249-4600 ��� <br /> ��''k�r�4`���� Fax: (952)249-4616 ' .� Approved By: ` <br /> - , �` <br /> � ,; � �, Amount$: � �� �� <br /> � ` i <br /> 1 <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 Site / Owner Information: <br /> Site Address: S'7 � �f� �SL� � <br /> I '� �.�-� Q� �f� <br /> Owner: I�V Mailing Address: /�Cf' <br /> City: �X c� �S J� � Zip: ,�,33 � <br /> Home Phone: Alternate Phone: ���7 ����� <br /> Contractor/Applicant Information: <br /> �-- `/ <br /> Contractor/A S�- Contact Person: ��l C� ' <br /> pp� <br /> Address: �'U State License #: Ll Z�P� <br /> City: � Zip: Expiration Date: ZD / � <br /> Phone: ?6,?L—��T� ����� �� � Alternate Phone:�63 -�7�r c��6/ <br /> TYPES OF OCCUPANCY <br /> ❑ Residential ❑ Commercial � Other ���/�% /C� ��'�or�-� <br /> ** ATTENTION APPLICANT ** <br /> Fill in all a ro riate blanks and check all a ro riate boxes. <br /> Tanks: � <br /> ❑ Precast Concrete �iberglass Plastic ❑ Other: <br /> Number of Tanks: Z <br /> Size of Tanks: l� D � �P D D <br /> Type of Activity: <br /> �renches ❑ 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 /> . � <br /> ��w�a �a ���/// �a�! '� � 1.D9 `��e� ti <br /> /f Page 1 <br /> ( <br />