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30-� City of Orono FOR CITY USE ONLY <br /> ° P PO.Box 66 Date Received: /1-22 <br /> // 2750 Kelley Parkway p' <br /> Crystal Bay,MN 55323 �,1� Permit# `jam© 1 (D cog <br /> - <br /> <:,..,A, <br /> ��� Phone:(952)249-4600 <br /> �`'Ars,{2 Fax: (952)249-4616 `1 r9 Approved By: _ -- <br /> Amount$: .�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 /> Job Site/Okmer Information: <br /> Site Address: 500 0 C 1 . --R--LC(,P bys' �. <br /> Owner: A)a v�-�--o.� i ' Yw.€5 U Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App: `---LA L'1eS -4' S^0 k.S Contact Person: 94-0 <br /> Address: "Z—(0 3 -- 5'4 S. State License #: L— C2 LL 0 <br /> City: i4'1-e/vt-/ 'D 4)-e Zip: ' S3 k 3 Expiration Date: 2-v /S-- <br /> Phone: 7&. 3 ` 1(7°!- /76 2- Alternate Phone: (2 & D G <br /> SSD <br /> TYPES OF OCCUPANCY <br /> Residential ❑ Commercial ❑ Other <br /> ** ATTENTION APPLICANT ** <br /> Fill in all appropriate blanks and check all appropriate boxes. <br /> Ta ks: <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: - ' <br /> Size of Tanks: / 30 (J (1 I l y /30D <br /> Type of Activity: <br /> n TrenchesMound ElPressure Bed n Chambers ❑ Holding Tanks <br /> ❑ Pre-Treatment n 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 />