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�o City of Orono FOR CITY USE ONLY <br /> 0 \ P P.O.Box 66 <br /> 2750 Kelley Parkway Date Received: I I I LI / <br /> Crystal Bay,MN 55323 Permit# 2-01(0'" 0 I L/3 y <br /> S,/ Phone:(952)249-4600 <br /> Fax: (952)249-4616 Approved By: <br /> Amount$: --/ 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: //7S- k66/Lia/ L/4/L1. ,2/v/Z- <br /> Owner:j i✓I(Js'Uy (A&Lk114 Mailing Address: 1/S.,-/S- rE/WiAxil i i.Jfl?n-1 <br /> City: t4ELI/NW MA) Zip: 553-I1) <br /> Home Phone: Alternate Phone: <br /> Contractor,/Applicant Information: <br /> Contractor/App: &2KaS F. W_°.GivLc]T7/Vg Contact Person: ',T IE, 1:31,t,12.& <br /> S. <br /> Address: 447 IZ(fvJ Z1 State License #: 1 ktsri <br /> City: M14./J(Z Zip: SS"3L e\ Expiration Date: ,J Zi/Zx/7 <br /> Phone: (q.sz) 455-3//z... Alternate Phone: (,Ll(Z.) /MS; <br /> TYPES OP.-IXICUPAMY <br /> Residential ❑ Commercial ❑ Other <br /> **ATTENTION APPLICANT -- <br /> Fill in ail appropriate blanks and check all appropriate boxes. <br /> Tanks: <br /> lig Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: 3 <br /> Size of Tanks: 12 1 Z`76) 1ZS7J <br /> Type of Activity: <br /> ❑ Trenches Q 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 />