Laserfiche WebLink
' <br /> ' O,¢p�O City of Orono FOR CITY USE oNLY <br /> P.O.Box 66 '' " <br /> 2750 Kelley Parkway Date R�cei�ec3, � Pemiit# <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 /> 'i ,.� �h � <br /> Site Address: �•� �'(.J� � • <br /> Owner: � �l �/CY'� (`/�� Mailing Address: <br /> City: ��/U/vt�r'/`--' Zip: <br /> Home Phone: ���...�� a (�� Alternate Phone: <br /> Contractor/App.: � Contact Person: <br /> Address: State License #: ���/ <br /> City: Zip: Expiration Date: olm�/ <br /> Phone: �� �.�� � q�� Alternate Phone: � � � <br /> �Residential ❑ Commercial ❑ Other <br /> � <br /> New or Replacement System $200.00 <br /> Repair Existing System 100.00 � �0 • �� <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total � C(� � � � c7 <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />