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���N�� City of Orono FOR CITY USE ONLY <br /> � \ P P.O. Box 66 �_�7/7�/� <br /> 1 � 2750 Kelley Parkway Date Received: d�� <br /> ,\1 _ Crystal Bay, MN 55323 Permit# ���7��d �� <br /> ,.\ ��% Phone:(952)249-4600 <br /> ��'�rsuoF�/ Fax: (952)249-4616 Approved By: <br /> Amount$: <br /> � 7 � ( <br /> , ti���� <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATI�N <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Job Site / Owner Information: <br /> Site Address: ��-�tJ �CC � ���� f <br /> Owner: Wt�' �c�� c�w1�E'S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App: �I�YC� (t�ri��� .SPUV�ZeS Contact Person: ( � Z�� <br /> Address: s ��f(� � State License #: <br /> City: . Zip: J�.��JL� Expiration Date: � ,3 � 7 <br /> Phone: 7�P�-- ������3� Alternate Phone: f�(�-3�y— /(�(r� C� <br /> TYPES OF OCCUPANCY <br /> `� Residential ❑ Commercial ❑ Other <br /> � <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: _,��v � �a � �� <br /> .� <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 />