Laserfiche WebLink
� ' , <br /> ,��� City of Orono II� FOR CITY USE ONLY <br /> P.O. Box 66 <br /> ��t,,,�a � 2750 Kelley Parkway �� Date Received: �����v Permit#a��� � �� � <br /> ��$�•`� � Crystal Bay, MN 55323 � <br /> �rA�`u'��o` (952)249-4600 Amount: $ O � _ <br /> ,��� � <br /> g�xp4 <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 i Owner Information: K���� <br /> � A � <br /> Site Address: � � (E^ C_1 � �— ,��- ./V � <br /> Own e r: ��-%r 1 (��✓� � {-4-+ l�h 5 �-l;,.�.� � <br /> Maili g Address: j�wkli� � <br /> /LI �a�,� <br /> city: �si�x����. -�'7� zip: ��_�5� <br /> Home Phone:°��j-�'� y"'2`f"7'7 Alternate Phone: C�; �Z - Cc-�S -� Z� <br /> ,�=Contractor/Applicant Information: <br /> � � . <br /> Contractor/App.: �����r, �( ������,� Contact Person: ��`��� <br /> Address: � �= � �� '�r >� ���� State License #: � � �' <br /> � ,� � �>.,. �, �<��c / �t,-f„«�.�iz� <br /> City: �'����' �'�`�X Zip: �� '� �� Expiration Date: ��-Y-�� ��� z����- <br /> ' " � �-Z _ cy Y�- � 5�-<. 1''�' <br /> Phone: �7 �7 ' `f 7�/ - ��7�' �----- Alternate Phone: <br /> ,�'��- � � � � � T1tP�ES OF_OCCU�PANCY <br /> �Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 � L�% <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> ;-�, <br /> Total � �_ � <:.. _ <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />