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. <br /> � ��pN�,, City of Orono FOR CITY USE ONLY <br /> � ', P P.O.Box 66 /1�� _ / / <br /> 2750 Kelley Parkway Date Received: �/ !�� <br /> l ,�, � Crystal Bay, MN 55323 ����� ?�/�, <br /> Permit# D � �`�. <br /> ;,\ Phone:(952)249-4600 �� <br /> \`'Kr,,,oF`�` Fax: (952)249-4616 Approved By: <br /> � Amount$: <br /> �/ <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: ,� �,� (_ ��r� _n. t�,,�G ���_ <br /> Owner: ,j ;;�, �_ �Xl��c5 J� ;- Mailing Address: _ �/7..,2.� 1,�'�f �.�,�,� <br /> City: `���r�r�b,.�{=L�;� Zip: - �.�� �5l <br /> Home Phone: (nS� - 02�)� � CU� �4� Alternate Phone: (o �� -�O " �S�� <br /> Contractor/Applicant Information: <br /> Contractor/App: C,l-���1�5 (_XcGv���-�-�G Contact Person: JtsS� LJc'''�n <br /> Address: �7 � ��: �jL,f`' �l- State License #: L33�U <br /> City: (� �..n���sS-��-1 Zip: `�5� I 7 Expiration Date: �{��,�- ���� <br /> Phone: �'15�- '�1 G�-�-��>�y Alternate Phone: `��.��,�c� /-�� 7� <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> ** ATTENTION APPLICANT ** <br /> Fill in all appro riate blanks and check all a ro riate boxes. <br /> Tanks: <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: ,� <br /> Size of Tanks: _�j(JC� l('X.:C� '1�UCJ <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 />