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( _ <br /> ��N City of Orono FOR CITY USE ONLY <br /> O P P.O.Box 66 <br /> 2750 Kelley Parkway Date Received: L� � �" � 7 <br /> � �y Crystal Bay, MN 55323 Permit# G�p /7 ' � � <br /> � p Phone:(952)249-4600 n <br /> �''krs�io0.� Fax: (952)249-4616 Approved 8y: /�� - <br /> Amount$: �Q <br /> - `�%�y/�7 <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: __ ) Sj�J � � �r'���! � `�w �{ <br /> Owner: v��^�-��, ���v�.`� Mailing Address: <br /> CitY� Zip: <br /> Home Phone: Alternate Phone: <br /> .Contractor/Applicant lnformation: .�__� <br /> . , _ � I <br /> Contractor/App: ,�1 �-( �'S >c�-� ' Contact Person: -''� . <br /> Address: �F�� �� �f- S L State License #: __ � (o ��� <br /> City: /�'l r.�,rfi�� Zip: _����� Expiration Date: ? , j �_ <br /> Phone: �7 C� �� - �7 �= '_/ 7 - ? Alternate Phone: � i 2_ (o� �J�� <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> r <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: ��- 2S� C�� �� � �oc� /� � '� <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 />