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F � ¢0� City of Orono � FOR CITY USE ONLY <br /> P.O. Box 66 <br /> �' � 2750 Kelley Parkway � � Date Received: �P Permit#a�dd�—60 3 <br /> � r� <br /> a�, t��r�,"'. ,. Crystal Bay, MN 55323 �� <br /> t� +�� ���-.o� (952)249-4600 Amount: $ • � <br /> ty����"o$s� <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 /> Job Site / Owner Information: <br /> � <br /> Site Address: r-�' � L� �� �`'�� - �� <br /> Owner: ._T��s��� C�<> �.��,�� � Mailing Address: <br /> City: C� ���=-�-•� Zip: � <br /> „c�h �2�rw.:a� <br /> #erx�e Phone:__ � t z� 5-�� - � 5��7 Alternate Phone: <br /> Contractor/Applicant Information . <br /> Contractor/App.: ��ye5 �-t S�>�.�s Contact Person: `� ��-tiv <br /> Address Zw3 �'� � Si - ���- State License #: �%`��-�' <br /> City: ���1{'i� Zip: s`� � � � Expiration Date: 2" `� <br /> ��� � <br /> Phone: �� 3 - `��Z- 3�Z i Alternate Ph�ne: 1 � � - �? S - � �CT 2_. <br /> . TYPES QF �CCUPANCY <br /> �Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Re I , �� � <br /> acement S stem 200.0 - v <br /> 0 <br /> P Y $ � v <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> ,.-v <br /> Total $ 2��� '�—� <br /> V:1(Permits)\Septic Perrnit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />