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, <br /> � �gp�� City of Orono �; F�R�7Y u��:��L� , <br /> P.O.Box 66 <br /> 2750 Kelley Parkway D�fe Rs�Bti� �Per[�li�� ��� ��� <br /> � � � Crystal Bay,MN 55323 G= `�,: <br /> �� (952)249-4600 �i1Qt�nt `; . $'� ' <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 /> ` , ! <br /> Site Address: � <br /> Owner: ��� ���Q,_. Mailing Address: <br /> City: �r01(1(j Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App.:���Q c�y�-� ��j,�j�(t . Contact Person: �n��SD� <br /> Address: �� �'y���[� � . State License #: I I I � <br /> City: Zip: o�o� Expiration Date: /�YIC.Lc./ I s�- ��f� <br /> Phone: ��o�- ������� Alternate Phone: (p/v�-��%-���b <br /> Residential ❑ Commercial ❑ Other <br /> New or Replacement System $200.00 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total � <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 /2 <br />