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• - RECEIVED <br /> ¢0 City of Orono FOR CI USE ONLY <br /> PO. Box 66 <br /> * , ' " 2750 Kelley Parkway JUN — 7 2010 Date Received / /0 Permit# 63©/4d ‘01/..3° <br /> K ?`: r?. Crystal Bay, MN 55323 / <br /> ___ otoe; (952)249-4600 CITY OF ORONO Amount: $ <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION 61/e/a <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Job0 1 O ner or nation~ , <br /> Site Address: `t Z 6,4—€_,G.-E-0,(,, <br /> Owner: R 0.,LJ 'k----=6-, :` Mailing Address: _ `l S 4 k•-/zr ' /-" <br /> City: 6,2kt57- 0 Zip: 5-5-35-1 <br /> Home Phone: Alternate Phone: <br /> Contractor/=Applicant Information; <br /> Contractor/App.: aA-V 5 'f S --}. 5 Contact Person: 6IR- P <br /> Address: Z‘ 3 52- sfi- SE State License #: CO (4 Q <br /> City: Mt.-frif.-vS-e Zip: S-5-365 Expiration Date: Z. v/ Z-- <br /> Phone: ;,--t(- 7 y /76 z— 5iy Alternate Phone: cc a /Z 6 g`S S-TS O <br /> Residential ❑ Commercial ❑ Other <br /> ! 'u t 4 `�.i� $ ¢ 'a r b *.:�. a _ r �4:1 <br /> ,,.. � � �� �x ;�PERM IT T�t�E ,FEL�Sa �_� �, �,� � ,� � � .� .�,h� 5��� , . <br /> New or Replacement System $200.00 '2_ 0 CD <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ v0 s <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />