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�0� City of Orono FOR CI7Y USE ONLY <br /> O P P.O.Box 66 <br /> 2750 Kelley Parkway �/� Date Received:_ �� � �� f � <br /> Z � Crystal Bay,MN 55323 �J'-1 � � Permit# ' ! ` ����;�� <br /> F �� Phone:(952)249-4600 �� <br /> �4KtsNoaE Fax: (952)249-4616 Approved By: <br /> AmounY$: <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/ CJ���r�r�for�,ati�on: <br /> Site Address: � � , <br /> Owner: (�9 �r.y�� l-l-�►�,n-G Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Gc�V.�C#�`1� iy�lt in�;�t�� -:�. <br /> Contractor/App: - -e 5 �v�.g Contact Person:`/�� <br /> Address: u 3 �`� 5�-S � State License#: �-� � v <br /> City: �'1��� Zip: ���3 Expiration Date: Zo � 8" <br /> Phone: � � 2 (��,� R'�� Alternate Phone: _?ti 3 -yZ -/7(0� <br /> � - - ''�!�`�'ES fl�OCC�.iPANC'� "t����.. �` ��� ' - <br /> Residential ❑ Commercial ❑ Other <br /> :.�; <br /> *�`ATTENTI�i APPUC�4NT*"` _ ' <br /> . , 'y ,, �, <br /> � �-` - �- Fil� in al� a ' ra � riat� blanks ant� �hec�;alt a � rc� r�ate b�x�es . '`� ,` � <br /> _,_ . <br /> .. .� <br /> T nks: <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: ),� <br /> Size of Tanks: _ � ZS� C��vU /.�dC) �� � <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 />