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11/20/2009 21:58 FAX 7834973566 SP TESTING INC �OS <br /> .. ,, .. <br /> . � <br /> Notifi ation: <br /> Y here y certify with my signature, as the Designe�,that al! data for the operating pemut <br /> appli tion is mie and conect the best of my knowledgc. I egree to irtdemnify and save City of <br /> Oron harmless from all losses,damages,costs and charges that may be incurred by the City <br /> becau e of my failure to comply with the provisions of this Ordinance. <br /> �-�- �J�-`--� ��'-1 �-1 -)�-0 3 <br /> Signa e of Designer MPCA License# Date <br /> ��� t�� ��-c.141 � �5 l 1�+�s�{o,o i.�4� l.tr. 7 fv3-`iai -3��� <br /> Printe Name 5�T- N?�t�►4-x1� N��1 S,S3�� Phone Number <br /> Address <br /> I here y certify with my signature,as the owner of the property where this system is ta be <br /> install d, that it is my responsibility to maintain an arumal operating permit in eCCordance with <br /> Oron Ordinance No. 199 and MN Rules Chapter 7480. It is the owners responsibility to infonn <br /> new p operty �wners of Operating Permit and Performance System. Operating Permits are noa- <br /> transf rable and all subsequent owners must apply for a new operatirlg permit with Orono. <br /> � ��-.�.� � � �.� ��,.�»;�r�����r��v�c�; <br /> -�..5.-r.� . �i-z _.�. <br /> ��.-°��� � '� � � � ���C�.��i�V•c..���-_�..+-�T�'v^>\r< ���.����-'�J <br /> Sig ture of Owner Printed name Date <br /> � 1���- �� '�3q � <br /> Ap ication teviewed by Date Approved or Denicd MPCA Reg.# <br /> 4 <br />