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' g0 City of Orono <br /> FOR CITY USE ONLY <br /> P.O.Box 66 <br /> O O hermitW 4, <br /> 2750 Kelley Parkway Ote Recewett, <br /> Crystal Bay,MN 55323 <br /> (952)249-4600Arroun�.' .. t � <br /> �ai,KoB�' <br /> Roo - Crr-) <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: h <br /> � � T U V <br /> Owner: Le w_\Jo it p"_- Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> laCoratcactp Ippr <br /> Contractor/App.: Contact Person: <br /> Address: -2- S , Sf 15 c State License #: L- 1_( CD <br /> city: Zip: 14vy' 5�30 Expiration Date: <br /> Phone: 71 2— Alternate Phone: (9 �Z 6 3-5- <br /> Residential ❑ Commercial ❑ Other <br /> G_. <br /> New or Replacement System $200.00 Z cc,CD <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> $ <br /> U <br /> ° W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />