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City of Orono OR C USE ONLY <br /> �O.AT P.O.Box 66 ae'22 7 <br /> 2750 Kelley Parkway Date Receive Permit# <br /> jil <br /> Crystal Bay,MN 55323 <br /> (952'249-4600 Amount. $ / Di <br /> ayes L� <br /> t`skESH0 <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 /> Job SLO:410Wner Informom. <br /> Site Address: -- () w(J L 'L ._ <br /> Owner: (2C MI d teYt S Mailing Address: <br /> City: 0)Ya7k-f) Zip: S -?,S---(-, <br /> Home Phone: 6(? -6,f" ,- 7/S -7 Alternate Phone: <br /> Contractor;:/Applicant Information: H <br /> Contractor/App.: cCX v......t sr cevv t S Contact Person: n----O 4 suJecJit../LJ <br /> Address: .„„ szdor.- 77?- 2 ) '�=- cil-, State License #: 2sO <br /> City: 2Il(Z pkV\LZip: 0o11 Expiration Date: <br /> Phone: 9-� r 7,? . 3)-99- Alternate Phone: <br /> TYPES Of OCCUPANCY <br /> 2c2Residential El Commercial 111 Other <br /> PERMIT TYPE ANO Pees <br /> New or Replacement System $400.00 6/�� -- <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> � r <br /> ` <br /> Total $ <br /> 1 / 2 <br />