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I <br /> City of Orono FO CITY USE ONLY <br /> .4 �O PP.O.Box 66 /-JR.� <br /> 2750 Kelley Parkway RECEIVED Date Received <br /> :3/31V(Crystal Bay,MN 55323 Permit#a9/7 <br /> e �, o, Phone:(952)249-4600 <br /> 44 Ho.. Fax: (952)249-4616 3 MAY 0 2 Q 17 Approved By <br /> /9C� <br /> J U Amount$: <br /> CITY OF ORONO <br /> CITY OF ORONO —SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Site Address: v 0 ( a c_ S t-c, ( c1; PcS2 <br /> Owner: C-OroYst-e rz,ti k_ Mailing Address: o c <br /> City: v kcn-., Zip: X5323 <br /> Home Phone: , Alternate Phone: <br /> Contractor/App: ,' J 4 S �C.M$ Contact Person: p <br /> Address: Z - fi S <br /> State License #: C_Co `{0 <br /> City: ,41-K f Zip: ; Expiration Date: 18 <br /> Phone: Alternate Phone: <br /> \I 'Residential ❑ Commercial ❑ Other <br /> kik tfir, <br /> Tanks: jib - v Z K���, � g <br /> h <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: 4(-4,1 F-T 5 T1 i /,,,� <br /> Size of Tanks: 7a0O fy q z7 <br /> Type of Activity: <br /> ❑ Trenches Mound ❑ Pressure Bed El Chambers ❑ Holding Tanks <br /> El 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 />