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R�NO P P OOBoxO66 no R���I Y�D FOR CITY USE ONLY <br /> � 2750 Keliey Parkway Date Received: • �� —�P �� <br /> ,\t Crystal Bay,MN 55323 O�T � � z��6 Permit# l./ —v� � <br /> ,.�V Phone:(952)249-4600 <br /> ` .`�a'i�x`�`~ Fax: (952)249-4616 Approved By <br /> . CITY OF OFZON(y 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: 3��P d 13ac�,. 5;r1� t�cf � �r�J C7 h O <br /> Owner: mG���'i'n Co�S fr u c -�'t or, Mailing Address: � a � m4 i h � � <br /> City: �l 1< ��v e►� Zip: 5 5 3 3 � <br /> Home Phone: �(� 3 -- ��b-- (� 3`7l0 ~ o F�ic � Alternate Phone: <br /> Contractor I Applicant Information: <br /> Contractor/App: �f u�-fS C;Y��u vtr{�r� 'h-�C�� Contact Person: ��Y <br /> Address: I S�' 9(0 10� ncl S �i- State License #: � 7 I �J <br /> City: 13r c. l�C� i' Zip: 5 5 30 � Expiration Date: aI alc�o 11 <br /> Phone: 3�o- �(.� �- / c� J J Alternate Phone: 7(0 3 -"� �� -U �'�� <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: J?' <br /> Size of Tanks: � ��,� (z l��Q <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 />