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O�'D�O City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 vhf <br /> a� 2750 Kelley Parkway Date Received: {� rmit# <br /> ` � : Crystal Bay,MN 55323 <br /> Q (952)249-4600 C(LVI Amount: <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: <br /> Owner: �GZf/`C GWt Mailing Address: S"W <br /> City: f Zip: <br /> Home Phone: Alternate Phone: Ld 72 <br /> PP L�t� AG1'`G�Contractor/AS)jo Contact Person: <br /> Address: kVX J� 7 State License #: FY <br /> City: /P� Zip: A111 Expiration Date: <br /> Phone: ZL a /9-0 Alternate Phone: <br /> Residential ❑ Commercial ❑ Other <br /> a v a... ..v... .,a _.✓s a u'ti. v .r MOW <br /> New <br /> ;d X a <br /> New or`Replacemen stem $100.00 no UU <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ zoo S� <br /> 1 / 2 V:\(Permits)\Septic System Permit Application.doc <br />