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��� `' City of Orono OR CITY USE ONLY <br /> �'� N��° <br /> O `,, P P.O.Box 66 _� /� <br /> � 2750 Kelley Parkway Date Received: % <br /> �,�, � Crystal Bay,MN 55323 Permit# �0/�O—���C/ <br /> �� ' t�? Phone:(952)249-4600 <br /> �`''�rs�ioF`.% 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 /> Job Site / Owner Information: <br /> Site Address: ` '`� � �--� � �--', �'`�- 2 � `" � <br /> Owner: �m � l�� �b �►�S ✓'�� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: (� 1 �Z `� !o O � �o � U � <br /> �� � 1� <br /> Contractor/Applicant Information: <br /> Contractor/App: -e ' "�S✓►��-5 Contact Person: �'� <br /> Address: Zi� 3 �2-� S'd`' � Er�' State License #: �- �v `�� <br /> City: ��'I ��s-c Zip: S `3 Expiration Date: ���� <br /> Phone: � �v � - Alternate Phone: <br /> TYPES OF OCCUPANCY <br /> i <br /> lResidential ❑ Commercial ❑ Other <br /> �. <br /> � <br /> ** ATTENTION APPLICANT ** <br /> Fill in all a ro riate blanks and check all a ro riate boxes. <br /> Tanks: <br /> _' recast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: � ' �x�S-��hs' l` �°2W <br /> Size of Tanks: >�(�� �(��I� 1��� j'�� <br /> Type of Activity: <br /> ❑ Trenches ��Mound ❑ Pressure Bed ❑ Chambers ❑ Holding Tanks <br /> � <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. R������D <br /> sEP o 9 zo�s <br /> Paye� C1TY QF pRONO <br />