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Aue-21-2012 02:01pm From-CITY OF ORONO +9522494616 T-665 P.001/003 F-961 <br /> _ Cy of Orono 'lai,..�ti4,•yA!i s�It.w^r;!4r�n"''•1I1:;j..5�.k.`irl.�": ��. t'��.;c:t:� .F�;i�o;'„_rr+,,r't:;'�.',�• j�;e:•'r:..;: <br /> 8 3 7o <br /> O! +OP.O.Bo66 .-a <br /> 2750 KelleyParkway <br /> Crystal Bay MN 55323 <br /> (952)249.460r <br /> CITY OF ORONO–SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the on-site Septic Manager andlor Building Official) <br /> Site Address: <br /> Owner: T Mailing Address: ),R <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: k.e A 0 6�67j ryc Contact Person: �2a—" <br /> Address: 21 oy (a y " ' State License M <br /> City: LU Zip: .S�'»o Expiration Date: o i3 <br /> Phone: z - © Alternate Phone: !�Ll- 7?.S--2 110 <br /> Residential [] Commercial ❑ Other <br /> 1111,11 1 lima 1 111111 11 111111il 1111 1 <br /> , <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:\(Pernnit5pepbe Permit Application.Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />