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.41101111° <br /> FCity of OFOR CITY USE ONLY <br /> w�N0 P P.O.Box 66rono r /_ <br /> 2750 Kelley Parkway Date Received: ! i'4 WO RECE' D <br /> A Crystal Bay MN 55323 Permit# <br /> s,. ► 4 Phone:(952)249-4600 `n <br /> `1k:slio Fax: (952)2494616 `V Approved By: gP DEC 2 16 <br /> 101' Amount$: Li 00 ' <br /> 1 CITY OF ORONO <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Job Site / Owner Information: l v OrePrz (41 /261 <br /> Site Address: v► z gociL J () 121-"L4-v (ZCI FIX-1124--t S, <br /> Owner: IIA nzle: L fr rA Lid ELIZv/ J Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App: g1A p,,c EV1,0 V 1/ fi n,c� /l,C., Contact Person: STI( . g1A Z N S <br /> Address: 3L-170 eL A ILAN iZ[)YaC_I Z I State License #: I 5( -K <br /> City: /r - )mixt,/EIZ Zip: ci 5(LD Expiration Date: 5 7O1"7 <br /> Phone: m5Z) gISs-- 112 Alternate Phone: /O/4 Le -S-- q363 <br /> TYRES OF OCCUPANCY <br /> 1$. Residential Commercial I I Other <br /> ** ATTENTION APPLICANT ** <br /> Fill in all appropriate blanks and check all appropriate boxes. <br /> Tanks: <br /> [it Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: 3 Z <br /> Size of Tanks: L 757 i0?1 <br /> Type of Activity: <br /> ❑ Trenches Mound ❑ Pressure Bed ❑ Chambers ❑ Holding Tanks <br /> n 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 />