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O' City of Orono P-)F) R USE ONLY �} <br /> P.O. <br /> 00 KoXley Parkway Gate Received/66 I D Permit o d !8 <br /> Crystal Say,MN 55323 <br /> AW <br /> (952)249-4800 Amount S <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 / Owner Information: <br /> - rf Site Address: � -� / - - 92 <br /> Owner: (/ �i� �/y ��'��S Mailing Address: �- <br /> City: d'fD 4/0 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.:4!FZM,e:5�e' � Contact Person: <br /> Address: State License* #a/ <br /> City: Zip: Expiration Date: <br /> Phone: ��. R,7.? Alternate Phone: A; <br /> TYPES OF OCCUPANCY <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <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 $ log::� <br /> W:1(PermAs)1Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 112 <br /> Z•d L I,ZL-ZL6-£9L •oo uosieled •f 1OW13 d00:Z6 06 60^oN <br />