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� � City of Orono ��CEfVED FOR C1TY USE ONLY <br /> Q � P P:O.Box 66 G�„�j: 1 1_ <br /> 2750 Kelley Parkway Date Received: T►�— l 1� <br /> „ Crystal Bay,MN 55323 ��p � 8 2016 Permit# 0 —� <br /> y� �� Phone:(952)249-4600 <br /> ���'FSNOQ'� Fax: (952)249�616 1, APProved By: � � � .. . . . <br /> ���,1' " Amount$: 0 <br /> 1 cirr oF oRONo <br /> a�� <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 /> ,Q � <br /> Site Address: �Cf � �b✓�` ' r�''� � � <br /> Owner: �v'�'f�zN� ��-c�w�-5 Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> � � ��. <br /> � v� <br /> Contractor/App: �`�'� �S �^`� Contact �erson: <br /> Address: State License #: L �P`� C.7 <br /> City: Zip: Expiration Date: 2� ��f <br /> Phone: 7 � ���7�7� T �� `Z Alternate Phone: ��2 ���^�e�� <br /> [��2esidential ❑ Commercial ❑ Other <br /> C <br /> Tanks: <br /> recast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: <br /> Size of Tanks: ZZ�( �e►►..I�o � QY.'"�� ��-fi 1 �v� ( � �— <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 />