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1 � <br /> 4pN City of Orono Foit c�'nr uSE oN�v <br /> � P P.O.Box 66 ��_ �_ �/ <br /> 2750 Kelley Parkway Date Received; f'�. <br /> ,� Crystal Bay,MN 55323 Permit# / a� � <br /> s.� �'� Phone:(952)249-4600 <br /> t�KfSNOQ'� 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 /> Site Address: C��, V �e � !` � <br /> Owner: /V�r�v �-. �-�-c�rn �s S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> �,, <br /> , _ <br /> �- <br /> � . Z n <br /> Contractor�App:�� , �-� -� � � �`��� Contact Ppers n: I-� �� ,J <br /> Address: � 3 � �d- �� State License #: L. (� � � <br /> City: ,��-r��s-� Zip: �5�3 ro3 Expiration Date: 2� � �Z_ <br /> Phone: __�'/�Z ��� 9 S��U Alternate Phone: �� 3�'`�'7� " / 2� Z <br /> �Residential ❑ Commercial ❑ Other <br /> Tanks: <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: ��O U <br /> , � <br /> Size of Tanks: 'Z Z �v Lv� lo-o �ol� L�w�' ,�fy,'�- �'� �� ��.�-- <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 />