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* � f <br /> Y City of Orono FOR CITY USE ONLY <br /> VO P.O Box 66 <br /> 2750 Kelley Parkway <br /> Date Received. 5/7//S Permit# 26/5:1(5656-3 <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ <br /> -.41. ______,y <br /> C <br /> xrto �. <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 I Owner Information: <br /> Site Address: 1 1 2 5- -Pi i< Vit) i R <br /> Owner: 1'1 t_k_i___ivi i 3 t- Mailing Address: <br /> City: &r-�,ic7 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: /174- 7 4, 1 S 1A fj Contact Person: W(4--.47 <br /> Address: 263 'Sfi S C State License #: L.-Co 't O <br /> City: tho-1 h'oct Zip: 5 -3,6i 3 Expiration Date: /1//ST <br /> Phone: 7( 3 �i ( 7� ' (o Z_ ___ a Phone: f Z 65 SSU <br /> TYPES OF OCCUPANCY <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $400.00 "96 0 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ 96)-C-- <br /> 1 <br /> /2 <br />