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, City of OrOno FOR CITY USE ONLY <br /> �-�� P.O.Box 66 � <br /> � 2750 Kelley Parkway l/ Date Received: �� Permif# ��� 3��0 sg <br /> Crystal Bay, MN 55323 �� <br /> (952)249-4600 �11� Amount $ <br /> y ,� �� � <br /> � G� <br /> CAk6S H��� <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 /> .,A�. irt. ���� k„ ,t� :f3k � t��"€,.�"� <br /> r <br /> , <br /> x•' ,t <br /> -_ ;.. � .� .�v ': . .. .�.:. . � .,... <br /> Site Address: <br /> �. c��C� ..S �l o�-e �r��-�e � <br /> S � � <br /> Owner: `���� a�` Mailing Address: <br /> City: C�/'�M-� Zip: S'��'3Z� <br /> Home Phone: � (o�Z- z-8v - �� �l � Alternate Phone: <br /> � _ � n � . <br /> �� 3 � . ,. <br /> : , <br /> . . ,� . . <br /> i,�, 2,' 0�1�5 Contact Person: ����� <br /> C�ntract�r/App.. � S <br /> -T� . <br /> Address: � � �� S'� �� State License #: �- � � � <br /> City: ������ Zip: 6�r Expiration Date: t� ��Z`��� <br /> Phone: ? �°� ���i�" � � � `�— A�1sr-��hone: �2 �2-- Cs���r' ��� <br /> , � _ � , , r _� . . , . _ �,� � �, <br /> r <br /> .� <br /> , <br /> � <br /> fi. � <br /> Residential ❑ Commercial ❑ Other <br /> � ,k _ . ; <br /> . . , . <br /> . , ,�� <br /> _ .�. e - � _ � ��,. , r � <br /> � �� . . . � . _. . <br /> New or Replacement System $200.00 Z� � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> � <br /> Total $ "�Z�-'� S � <br /> W:\(Permits)\Septic PeRnit Application-Updated Surcharge 07-28-11.doc <br /> 1 /2 <br />