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� <br /> Clty of Orono FO C)TY U8E ONLY <br /> �o�a P.o.BoX� y�� <br /> 2750 Ke11ey Parkway Date Receiv�� I Permit#��!S'b ��� <br /> Cryslai Bay,MN 55323 <br /> (952)249-460� � Amaunt: a <br /> a I � <br /> �ti� � � <br /> � ���� <br /> `q'rFS H Op'� <br /> CITY �F OR�NO - SEPTIC SYSTEM PERMIT APPLICATiON <br /> (All permits must be approved by the dn-Site SepUc Manager and/or Building Otfiaal) <br /> Job Sife !Owr�er fnformatwn: <br /> Site Address: � <br /> Owner: � N <br /> � Mailing Address: <br /> City: � � Zip: <br /> Home Phone: Altemate Phone; <br /> Contractor/Applicant �nformation: <br /> Contractor/App.� Contact Person: � } <br /> Cl�G9?/ <br /> Address: J� a State License : #�/ � <br /> � <br /> City: Zip: S�S3d� Expiration Date: <br /> Phone: 7�3 ' ��o� ' �?�o�D Aiternate Phane: � <br /> � <br /> TYPES OF OCCUPANCY � <br /> [�Residerrtial ❑ Commercial ❑ Oiher <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $400.00 �o4,pD <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> Total $ 'f�``'/D, p D <br /> 1 /2 <br /> l'd L6ZLZL6£9L o�uosaa�ad�aawl� �0£�Ol5LZ6 �nb' <br />