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� <br /> O,�D�O City of Orono FOR CITY USE-ONLY <br /> P.O.Box 66 <br /> : , .,: <br /> 2750 Kelley Parkway Date Received:; Permit# <br /> ����� Crystal Bay,MN 55323 `: <br /> (952)249-4600 Amount: $ ` <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building O�cial) <br /> Site Address: �� �� L— � i � �N �� �j�: �j� <br /> Owner: �� S d-�,�4 Y � �'�'Daril � Mailing Address: <br /> City: �� 1�('J�, f�f V �l �� Zip: <br /> , <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: �,� � �. <br /> ,�r. Contact Person: �i� e /'�iv� <br /> Address: �v �7a CaGrvl�,l� I�v �� State License#: � �5�_ <br /> , <br /> M � ���� � � <br /> City: Zip: y Expiration Date: ��'�-� <br /> Phone: �o!Z-3��`�3��/ Alternate Phone: � ����5�_����1 <br /> �Residential ❑ Commercial ❑ Other <br /> New or Replacement System $100.00 `�a� ��', <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />