Laserfiche WebLink
City Of Orono FOR CITY USE ONLY <br /> {� P.O. Box 66 <br /> �./ 2750 Kelley Parkway Date Received: ' /Q7 j15 Permit# -cn 565 <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ <br /> `�kp5ttO�� <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 /> Site Address: �'� 1"o et �4w h <br /> Owner: Govdo'vl Mailing Address: <br /> A. <br /> City: /!i/�/�(� G�t� zip.- <br /> Home <br /> ip:Home Phone: Alternate Phone.- <br /> Contractor/Applicant <br /> hone:Contractor/Applicant Information: <br /> Contractor/App.: -eS +S G;,\ Contact Person: r <br /> G� (Q <br /> Address: Z `/ f State License #: 1 <br /> City: Zip: — (4 Expiration Date:Ce <br /> I _ <br /> Phone: 6 ' 7 y 76 A tePhone: t�o f' Z b8 eis 5z) <br /> TYPES OF OCCUPANCY <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES' <br /> New or Replacement System $400.00 �L D <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> c� <br /> Total $1 /2 <br />