Laserfiche WebLink
� � '�. / <br /> � City of Orono i/ FOR CITY USE ONLY <br /> �4 0\ P.O. Box 66 �D ' <br /> �,,,r,. � 2750 Kelley Parkway �J�� Date Received: Permit#o2o'O�– DO o2/ <br /> ��� ��Y�',��,i`'�. F ' Crystal Bay,MN 55323 4 <br /> �����Fp4�o` (952)249-4600 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 /> — --- <br /> � Job Sife / Owner lnformation: �� ; � <br /> Site Address: �- �' �S 2-���� �1�! <br /> Owner: S �� �� �/ � ������ Mailing Address: � �`���� ��`'"�`� �"�' <br /> City: �Vzh-�.� Zip: <br /> Home Phone: Alternate Phone: <br /> ;x � ra��orJ:Applican� Informa���� ` ������� <br /> Contractor/App.: �-�� -� -�s �� �s Contact Person: ���� <br /> Address: Z� 3 � � S f � � � State License #: � `f� <br /> City: /���fY�� Zip: S��l �3 Expiration Date: Z � � o <br /> Phone: �-�� , (� !2 - (� ��'- - j�� Altemate Phone�`�� 7�3 -- �7�j �—j�7�� <br /> ��� � ����� ���p.E"�`��'��� �y� ��.� � ���,� , R��n �� � � � <br /> `F' $ 'q! � �� .i"�„ � _ ���tl Z.����"V��"�Y���.S'3�`�';�db^�'A� 1 �'g�,�'�i.+Sktii�i'''����,s� , <br /> �] Residential ❑ Commercial ❑ Other <br /> �������,�}s:���"����n�� � �"�,'�:�Ah� {��m�,�x�ar,� . PERMIT TYPE AND FEES <br /> New or Replacement System $100.00 <br /> Repair Existing System 50.00 �U <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total su <br /> � �v - <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />