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0 9 7 93 a-- <br /> -o City of Orono 12-Z.0� FOR CITY USE ONLY <br /> �P 0 P.O.Box 66 <br /> 2750 Kelley Parkway Date Received: I YZ�O Permit# o?Gvq-OD? 70 <br /> 14 <br /> 4r Cry ,MN 55323ffe <br /> yc (952)stal 249Bay-4600 Amount: $ l00 <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 /> Ro3Q5 ÷ D S +e <br /> Job Site Owner Ir�f©rr anon <br /> Site Address: OO LtjA4 -211 i A 1 o i 1e11 ( ct t)c' rt' <br /> Owner: W �'t 7 A A C a.�A r-j C t�3 Mailing Address: <br /> City: WAZATA Zip: 553il <br /> Home Phone: °I5-02- L-17 " 17 3 Alternate Phone: c,t,2_ 5?a I - SSo3 <br /> Contractor I Applicant Information, <br /> Contractor/App.: Contact Person: I o(3 et 4- D <br /> Address: State License #: A//4 <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> . TYPES OF t CCU ?ANCY s._ <br /> ❑ Residential Commercial Other <br /> PERMIT TYPEAND, FEES. ., aa; . <br /> New or Replacement System $200.00 <br /> Repair Existing System 100.00 f 0 0 - 00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ /D d• SID <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />