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May-07-2010 03:18pm From-CITY OF ORONO +9522494616 T-241 P.001/002 F-040 <br /> City Of Orono •.'FOR.CITY'USE ONL. <br /> 4'O� PtJ.Box 6 <br /> <446034 <br /> O .AateReceivetl:: �iq 'th;::Permit# o?Qy�-P 36 <br /> 2750 KelleyParkway „ . <br /> 47 <br /> j Crystal Bay.MN 55323 <br /> r yi (952)249-4600 Amount.. <br /> ss.. <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION <br /> (Alt permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> T iff/ : • ysion .°! <br /> Site Address: '18 I,JDaf, , ( - <br /> Owner: /haat.,.. etQ,lc. b Mailing Address: )2 7 E c1f ewe_ <br /> City: &Gilt_ Com..,. id C ��ip: 53I/ 7 <br /> Home Phone:6 t?_y8 / - 3 2-1 i v Alternate Phone: <br /> ffigt#^ t u+r a ru wr mdawn V.e r naI+L <br /> Contractor/App.: LF-e.o"je, ,EXt^,}1,•i}�i rvv-Ewe Contact Person: ,:; $1. 4.6'/e° <br /> Address: a/o y , yam' ' State License It: / -7 78 <br /> City: -,E0.4.&i.i►„�,. Zip: .C57/6 Expiration Date: a4 s za i/ <br /> Phone: 4 . S/-'/ Z (o -Z*'41 Y Alternate Phone: e. S/-7-3 Z//o <br /> °, Ti (,fj ui • 7413574' Iii 1;401 1!' i J.',ce - I .r II .4 . .1(.11:::it1t,l 1:o&kkiTtoViiilo 11n. <br /> J Residential ❑ Commercial [] Other <br /> OMB' '�lPl�(�£ .Lr "'`��,,,����I�' '�pI'��I � i �' "�a.lh�.6"� I' {�1}� li ait; ��{,h 1tf �bl� 9i {'I `' <br /> {{�! rl VY ', '; ,l t. ^ZIt,,i<Z 6 '�611 i =UI lilt y�Sd d USEIV 1 N' j i�++''a 8t7•y i kik li.fli N W�AI) <br /> New or Replacement System $200.00 <br /> Repair Existing System 100.00 /no..e” <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ I op .S° _ <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009,dOc <br /> 1 / 2 <br />