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� ,¢�� City of Orono q FOR CITY USE ONLY <br /> O O P.O.Box 66 .� � <br /> 2750 Kelley Parkway �'� Date Received: �����/ ' Permit-# �� S, <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 Official) <br /> Site Address: � � S��' � h f �4� �`� • � � <br /> Owner: �l�V� (�y� / � Mailing Address: CQ v S��b6 S ��7 Y� ��� <br /> City: � C"� v���-, c7 Z�p: ' <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: ���1 y-�5 �--5� S Contact Person: ��o <br /> Address: Z6 3 Fz L='P sfi �� State License #: � �'� <br /> City: /??°��`�� Zip: s�5�� 63 Expiration Date: z�,�'o <br /> � <br /> Phone: 7� � ' `�7T- / ?6 2 Alternate Phone: �3Cor 2 - b��-- ts.s� <br /> � Residential ❑ Commercial ❑ Other <br /> �� . <br /> New or Replacement System $200.00 ('} �, �Q <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) .. <br /> State Surcharge .50 .50 <br /> Total $ ��� , ��j ` <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 /2 <br />