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�� City of Orono FOR CITY USE ONLY <br /> � P P.O.Box 66 f.� <br /> 2750 Kelley Parkway Date Received: l ' ��� � <br /> Crystal Bay,MN 55323 <br /> Z� �: Phone:(952)249-4600 Permit# �7` � <br /> �'�krsno0.� Fax: (952)249-4616 0 . Approved By: <br /> ■ /� <br /> n , �v- ��\ \� Amount$: <br /> W/'�/ <br /> l lr <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 /> , , � <br /> Site Address: � C_ � �. � � +�/>�� c:w , <br /> Owner: _ `_� �_��-,.��;�^,, �-.�.��.�,,� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> pp nformation: � <br /> Contractor/A licant I� _ µ^� �.-.. ' <br /> . <br /> Contractor/App: i�} �.� � 5 �� �� 5 Contact Person: � <br /> Address: '�--�� �2 '=� �f � �c.' State License #: _ L � `1� � <br /> City: �'1 � •1-F �� Zip: 5"���3� '� Expiration Date: 2.C�/ � <br /> Phone: �� U � �� �'� �� - � ?�� "��--�� Alternate Phone: �-��_ �;. �� � � 5��� <br /> •� TYPES OF OCCUPANCY <br /> �'Q Residential ❑ Commercial ❑ Other <br /> ** ATTENTION APPLICANT ** <br /> Fill in all a ro riate blanks and check all a ro riate boxes. <br /> Tanks: <br /> �1 Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> �Number of Tanks: '� <br /> Size of Tanks: Z�L `>'v � c'�''1�v � � u.� ( �� <br /> Type of Activity: <br /> ❑ Trenches A�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 />