Laserfiche WebLink
�04 City of Orono o�R ITY-A sf O LY <br /> O O P.O.Box 66 0 &P <br /> CA <br /> 2750 Kelley Parkway it <br /> Crystal Bay,MN 55323 , <br /> (952)249 4600 Amount $gr"i° <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: /'l r All, Mailing Address: 7 4-� � i,✓. �„�,... �2�( <br /> City: rd A<0 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App, -rt �C 5% sr�- ins�, Contact Person: <br /> Address:l �a 7 �l Lf kV State License #: 4 -714 <br /> City: Ld V' -40 Zip: 3 7 Expiration Date: a0 I�2, <br /> Phone: �[� �— �7�'— 1"� Alternate Phone: ie Q, Fqa -7,171 <br /> Residential ❑ Commercial ❑ Other <br /> XNew or Replacement System $200.00 2y 0 . Vy <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ p -T- , C)o <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 /2 <br />