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/ ILQN City of Orono FOR CITY USE Q�JLY <br /> Q P P.O.Box 66 _1'9 <br /> 2750 Kelley Parkway Date Received: <br /> A <br /> . Crystal Bay,MN 55323 Permit# /A 12)-- 0 0 14 1 <br /> 1, . Phone:(952)249-4600 <br /> ,4 sHol,t Fax: (952)249-4616 Approved By: 4.4.,./ <br /> Amount$: late. 00 <br /> CITY OF ORONO -SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Site Address: 1 [2.. (y/Si O e frc4i / <br /> Owner: /' m 140rYIa CoM+rtic1lailing Address: `//3 Pau t A-v 5 <br /> City: Co lone_ Zip: SS <br /> Home Phone: Alternate Phone: <br /> Contractor/App: Chu (k5 Exccotc -, n 3 Contact Person: )-e,$,5-e_ <br /> Address: 7(0(7 m 9(ofl S is State License #: L. <br /> City: Chc„-) 114S5{ ,i Zip: 55317 Expiration Date: '-I"d?a- I b <br /> Phone: 95(4- A 4 (o ` 028 7 V Alternate Phone: c(Sa-0201 -ab 7y <br /> g 1 .. `'' __ t Es z , . .,,fr.:, „,,U,:,.;`, t ✓:c ..': ;;„ :,,�..d4 '^ 4 1 4�"�z.`` ilr <br /> ce_ <br /> Residential ❑ Commercial ❑ Other <br /> I dr \ F G 6 Ig er r1: 1" t t ',77 ;i74,5P r w� W s�" �14. r .rr <br /> 14 <br /> , 4:2 . < � J r .F wra it ���� E. s1 , <br /> „ � � F"' � ` � C1-=,. c— th; ') rra e ( , ',;(,-;(., 'i.': <br /> 4;is 1V <br /> Tanks: <br /> EiX Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: <br /> Size of Tanks: a.a.50 1 SOO <br /> Type of Activity: <br /> ❑ Trenches N 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 />