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r <br /> _l <br /> ;•�� ,�, ,,��` City of C7rcano _� . Fo CIT U5E�NLY Y <br /> /' �`<-t.(� �� P.C�.Bax 66 / ��/ .� <br /> / � � 27SC�Keiley Parkway Date�ec:eiveti`/ Permit ti �d�5—b� -f�LJ <br /> ( Crystal Bay,MN 55323 ,y'� <br /> ' I (952}249-460d Amount: $ �/l/ <br /> � � 1 _ <br /> � <br /> s. <br /> �iy E 1 �� � <br /> C� <br /> �`��Ftil��'�� <br /> CITY OF ORON�C1 — SEPTIC SYSTENI PERMMT APPLICATION <br /> (All permits must be a�praved by the On-5ite Septic Manager and/cr Building Offieial} <br /> Job Site / t�wr�er Informatic�n: ' � <br /> 5ite Addre�s: ' �'; <br /> .�_ � � , � ,. <br /> Owner: �w��' '�,� ��� ` �����`� � F` � �`��"fr MailingAddress: <br /> � <br /> e_ x ( �` i <br /> � <br /> / <br /> 5 /,��N�� ; <br /> c�ty� �`f_ �.�� f � z;�: . <br /> 1 <br /> Home Phone; �;i� ��' ��_ �t �� �. ��' -t_,� A(terrrate Phone; <br /> _ _. _ <br /> Con#ra�tor/ Applicant lnformatic,n: � _-- <br /> 1 <br /> Contractor/A � ��� � -- -� � <br /> P�-� �'_.�._ C�ntacf P�rson: �'��-���� ��;:' ��� f��.��.. <br /> J� 1 <br /> r <br /> Addres�: 1` , ° ��', y, � _„ . _, , ��, �� S��te Licens� #: ;".�'� ,� ' � <br /> City: ;_,� � f�_; ,, � �'_ Zip �,��. �''� ,' Expiratian Date: <br /> , � <br /> � ; <br /> Phone: �'_�; ,``��z � a ������ Alternate Phflne: <br /> � co 3 � Zg�- �7� Z. <br /> _ � _� <br /> _ _ TYPES OF OCCUPAhI�Y ` <br /> ❑ Residential [� Cammercial ❑ Oth�r <br /> ; <br /> � __ _ R��re�i-r -r�r�E �,�� �EEs -- � <br /> �o <br /> New or hZeplacement System $400.00 �"�Q — <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfieid) <br /> m� <br /> Total � �� � <br /> ; , � , . <br /> � �..� �. � <br /> 1 / 2 <br />