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. . � <br /> �O`y P 0 g X O�rono FO CI USE ONLY ; <br /> � 2750 Kelley Parkway '���, Date ReoeiveG:� Permit 1f��� ��J" <br /> Cryslal Bay.MN 55323 ' <br /> (852)249-4600 ' AmounC $ �o.s,O� <br /> a a <br /> y� � <br /> C <br /> l�fSH��� <br /> CITY OF ORONO—SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approvetl by the On-Sile Septic Ma�ager andlor Builtling Otficial) <br /> ' Job Site/Owner fnformationc� <br /> Site Address: �'�'�C')tL^�,p�. -��.P. IV ���� <br /> Owner; �.��1 ���'1Y,�('41�tY1 MailingAddress: ,�SJS I'IYjI'111'�((� <br /> l.Ctn.e� <br /> ary: C��tX'1�lL,- ov�,�.Lle� zip: w�c�L��1� �I""7 <br /> Home Phone:__�l� a��G _ �U�$ Aitemate Phone: '� <br /> Contractor/Applicant Inform�tion: <br /> Contractor/App.:��t�`���LC, LU`yl`'i�U� Contact Person: Lc�,r� <br /> Add ress: `��t-1 a �s ' -�� State�icense#: Q�7 ���-13 G 3 <br /> City: � Zip: `�J�� � Expiration Date: i� �i S <br /> Phone: �C..P 3�4�� ���U Alternate Phone: <br /> � <br /> ` `` TYRES F OECUPAl+ICY <br /> �Residential ❑ Commercial ❑ Other <br /> � . PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 <br /> Repair Existing System 100.00 �� • OC� <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ <br /> W:kApplicaUons,Licenae or Pertnit ApplicaUons)�Permits\Septic Permit Application-UDdatetl Surcharge 07-28-11.Ooc <br /> 1 /2 <br /> r .. , <br />