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��l <br /> � <br /> � ' ,¢�� City of Orono FOR CI USE ONLY <br /> O O P.O.Box 66 �� , <br /> 2750 Kelley Parkway Date Received: � f1 Permit#� � <br /> �. Crystal Bay,MN 55323 <br /> ����y� (952)249-4600 Amount: $ ��•� <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION <br /> (Alt permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Site Address:_�a� 11J�1 (� rm �t,��ip <br /> Owne�: ��j ��D t� Mailing Address: <br /> c�ty� �Nc`� z�p: <br /> Home Phone: �'S_oTI�Q -`�,� Alternate Phone: �j�9- �3� <br /> Contractor/App.: �P�o��������� Contact Person: � <br /> Address: �7r'j��_f�/Sf �� state �icense #: /5 <br /> City: (.v Zip: Expiration Date: <br /> Phone: �7_�=�a 9 Alternate Phone: �7-��-Q7a� <br /> � Residential ❑ Commercial ❑ Other <br /> 00 <br /> New or Replacement System $200.00 �f,lp <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � a� � <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 /2 <br />