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City of Orono FOR CITY USE ONLY <br /> jY\\ P.O.Box 66 �y <br /> �yit, 2750 Kelley Parkway Date Received:.7/5,5/99 Permit# ?009 OO a <br /> ria <br /> -�' Crystal Bay, MN 55323 <br /> f ( ) Amount: $ G?0G•J�—v <br /> t� a 952 249-4600 <br /> \�Ss�u$y <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 /> • <br /> Job;,4#e/Owner I o t <br /> Site Address: 7 0 Ll)e�,/ LC- vL S <br /> Owner: J &k,5 PC-c ( s Lev- (Go---tom, J a 5) Mailing Address: <br /> c'c.,),.51-- <br /> City: <br /> n,STCity: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applica:1-ijt I rf orma`tion <br /> Contractor/App.: Id �y e 5 `f `-,`"-- -5 Contact Person: `>rzA 0 <br /> Address: 2(9 ? �� S+ S State License #: ' 0 <br /> City: fivti5x Zip: 53-3L'3 Expiration Date: -?_<.., (0 <br /> Phone: 7 6 ? ?& Alternate Phone: 62 ( 2 e g5: S�-zResidential ❑ Commercial ❑ Other <br /> New or Replacement System $200.00 Z e'c <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 Z a� .50 <br /> Total $ -z c7v s% <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 /2 <br />