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¢O City of Orono jFO�RpCII USE ONLY -yam '�f�/�'7 <br /> _ 1' 2750 Kelley ParkwayDate Received/ / 461 Permit#�� (J�/ 7./v / <br /> y <br /> Crystal Bay, MN 55323 :,q0 CTS <br /> �•�,��•� (952)249-4600 Amount: $ w�''J�-' <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 /> Site Address: ( /eet, <br /> Owner: )KZA/V /14r-/$17 Mailing Address: <br /> City: p/'O/?D Zip: 535 2 <br /> Home Phone: Alternate Phone: ZO 2 -q 7 'a. <br /> Contractor/-Applicant Infor-a at an <br /> Contractor/App.:7),iJeCYf rrf 4-Casefeotiltact Person: l Sedo(=z7.-6_, <br /> Address: 97$ •"(d6/r.7( heel ekI State License #: 2 3 5-0 <br /> City: pUGZ ,-TO1.-Az Zip: .C.C.? 8 Expiration Date: dt/o r/ - 2 o /O <br /> Phone: 72 �P'6-rs'e Alternate Phone: 6/2 S32- ,11'1Z_ <br /> TYPES C P N <br /> pl Residential ❑ Commercial ❑ Other <br /> 'PER IT'T PE ND EE'S <br /> New or Replacement System $200.00 - <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ 2Oo <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />