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City of Orono FOR CITY USE ONLY <br /> 114 - PP.O.Box66 <br /> 2750 Kelley Parkway Date Received: 4/3-5--/7 <br /> r Crystal Bay,MN 55323 Permit# � li 7 / CP? <br /> Phone:(952)249-4600 <br /> 44 HOPE Fax: (952)249-4616 Approved By: <br /> Amount S. <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 Address: 1t 4E St <br /> Owner: }4p Q-i. [ ( . , Mailing Address: k S'S 144-bJ--- ttit,, <br /> City: �- -- /,1.-J Zip: 2-:- <br /> Home <br /> ,Home Phone: 4012- 2:7 i_ 1c/'0 Alternate Phone: t '/2..Z2 1- Ne <br /> S.4s T?_ - ,vo f trA <br /> Contractor/A <br /> PP: ����x-� g�'�s • . Contact Person: <br /> Address: ?c. ��,� S'� State License #: L 2424 <br /> City: 1-17-1,,0.12r- J14J Zip: s`S 34' / Expiration Date: Z t)C <br /> Phone: ri a -22 I- 1-1 Alternate Phone: 442 -ZZ/_ /'/`33 <br /> f Residential ❑ Commercial ❑ Other <br /> El.7 <br /> .lc ,., � f � � ..w`' k.s.. ..t � ... � 4 <br /> Tanks: <br /> Ng Precast Concrete ❑ Fiberglass ❑ Plastic <br /> ❑ Other: <br /> Number of Tanks: Z <br /> Size of Tanks: 22.5t h444.0, /3tb <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 />