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, ���N�, City of Orono FOR CITY USE ONLY <br /> � �• P P.O.Box 66 R ��/� <br /> l 2750 Kelley Parkway Date Received: / <br /> ,\y � Crystal Bay, MN 55323 /— <br /> Permit# o�0�(�_ Q/���C7 <br /> �<<� �� Phone:(952)249-4600 'z <br /> �C7 <br /> \''ai,,,oF`�' 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 /> Job Site / Owner Information: <br /> Site Address: '�]p(� V ����(���1'� lJ..�.�� <br /> Owner: S��� �C�,1�T�� Mailing Address: �-t��� 1,U2 S� �.`�- <br /> City: ��R��v..�``�'�, Zip: � �,� � <br /> Home Phone: t�s� ` �C1�- C�(7a Alternate Phone: 1���-�,�C� -uSoZ� <br /> Contractor/Appticant Information: <br /> Contractor/App: �-b I�� �'u�N�Q_ �Gt�-4CZ�-c�Contact Person: ____� �� X <br /> Address: �(� ���� � S State License #: ��CS���7��� <br /> City: 6 � �� � Zip: S� �o� Expiration Date: <br /> Phone: 02 " b- �. o� I Alternate Phone: lc7�� - S�y��� � lo <br /> TYPES OF OCCUPANCY <br /> [� Residential ❑ Commercial ❑ Other <br /> ** ATTENTION APPLICANT ** <br /> Fill in all a ro 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: 1�(�ZJ �Q�(� ��G <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 />