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O$ +0City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 <br /> %(.• 2750 Kelley Parkway fJete Recx3Ned Permit*.O 8' <br /> Crystal Bay.MN 55323 <br /> + b` (952)249.4600 Amount S BL <br /> CITY OF ORONO—SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits Must be approved by the On-8119 Septic Manager and/or Building OEFkial) <br /> Job Site/Owner Information: <br /> Site Address: 3725 WATERTOWN ROAD <br /> Owner. WADE SHATZER Mailing Address: 3685 WATERTOWN ROAD <br /> City: MAPLE PLAIN Zi P 55355 <br /> Home Phone: (952)200-9222 <br /> Alternate Phone: <br /> Contractor/Applicant Information: <br /> ContractorlAPP•- Contact Person:DEAN BITNER DEAN BITNER <br /> Address: 10337 TWIN LAKES RD NW State License#: L1595 <br /> ELK RIVER 55330 05/04/2009 <br /> City: ELK Expiration Date: <br /> Phone: (763)241-5288 Alternate Phone: (763)286-3148 <br /> TYPES OF OCCUPANCY <br /> [� Residential ❑ Commercial Q Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $100.00 $100.00 <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ 100.50 <br /> VA(Permits)1Septic System PermIt AWIcation.doc <br /> 1 /2 <br /> Z-d L55g-LvZ (£9L) b3NAEI 310ENVY '8 Nd30 e6V90 80 9L deS <br />