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� <br /> • Clty Of O�OIlO FOR CITY USE ONLY <br /> � �� P.O.Box 66 <br /> 0 2750 Kelley Parkway DBte Received: Permit# <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ <br /> � � <br /> y�. : <br /> G <br /> `qkFSH��� <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: ���� �t��� � <br /> Owner: ���T� ��.` 1 'f Mailing Address: <br /> City: � '��1�� Zip: <br /> Home Phone: Alternate Phone: <br /> x <br /> n;�.: <br /> z � _ <br /> � v'h ��- Contact Person: � ''` <br /> Contractor/App.. c�11�2� l T� <br /> Address: o��� '' �� ��• State License #: ���� <br /> City: �l� ��� Zip: 6 � � Expiration Date: <br /> Phone: g�O��' �� � J� ! � Alternate Phone: ���o,�� ��� <br /> kA <br /> �] Residential ❑ Commercial ❑ Other <br /> G \ <br /> New or Replacement System $200.00 <br /> av <br /> Repair Existing System 100.00 ��� � <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ l �5� � <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 /2 <br />