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^ , ��i .# �p �o�v`� <br /> ' City of Orono FOR CiTY USE ONLY <br /> �"�� P.O.Box 66 C�DIO D D �'I �D <br /> Q; 0 Date Recaiuetl:q_� Permit# "� <br /> �.�. <br /> �� 2750 Kelley Parkway <br /> �r '` Crystal Bay,MN 55323 <br /> �����`'�i�..c� (952)249-4600 AmguYtt: $�Q�/��� <br /> ���� <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 /> �", ��� �Y� Y �� .j"'i;,,�� � <br /> s�teaaaress: 2135 Salem Court Orono <br /> owner: Ervin & Michelle Wachman Mailing Address: 2135 Salem Court <br /> c�ty: Long Lake Z;p: 55356 <br /> Home Phone: �612� 63G-2089 Alternate Phone: <br /> F. �: z <br /> h x , , ; . : - � h ,, _: ��, <br /> Contractor/A Burns Excavating, �11C. Contact Person: St@V@BUI"C1S <br /> pp� <br /> Address: 3470 County Road 21 state �icense #: � 888 <br /> ���,: Mayer Zip: 55360 Expiration oate: 3/21/2011 <br /> Phone: (952� 955-3112 Alternate Phone: (612) 685-4303 <br /> A �.;f ,� � �< � � � � a.. � 4 <br /> ❑■ Residential ❑ Commercial ❑ Other <br /> ,-' ,� �:� ` c."�" -l'�" ��.'� ; � �« � w :,� � � �� <br /> � <br /> ,, <br /> - .�.�.r r_�.e. ,,,'i _�,.� . .�.... ...... ...: .....:,F..., ., � .,� . � ,. . . � �:. ,L „s <br /> � <br /> New or Replacement System $200.00 200.�� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Tota� �205.00 <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 /2 <br />