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e ��NO C i�pBoQrono � FOR CITY USE ONLY <br /> 2750 Kelley Parkway Date Received: /!�D�—/��9 <br /> � � Crystal Bay,MN 55323 � Permit# ��o —��� d" ,/ <br /> �� Phone:(952)249�+600 /� <br /> '�,,,,ow` ` Fax: (952)249-d616 �i i Approved By: <br /> � Amount$: �(/V , � <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 /> i' = � � Cv <br /> Site Address: � �� DO <br /> Owner _����� Mailing Address: <br /> City: ; �u� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> , <br /> Contractor/App: -.��t-�� Contact Person: <br /> Addres : � � CJc State License #: <br /> City1� Zip: „� ��,'� Expiration Date: <br /> Phone:�,3 � �7� J ���(� Alternate Phone: <br /> TYPES OF OCCUPANCY <br /> �] Residential ❑ Commercial ❑ Other <br /> � ** ATTENTION APPLICANT ** <br /> Fill in all appropriate blanks and check all appropriate boxes. <br /> Tanks: <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: <br /> Size of Tanks: <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 />