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of Orono FOR'CITY'USE ONLY <br /> Box 66 <br /> 2750 Kelley Parkway Date Received: eV Permit# / © <br /> Crystal Bay,MN 55323 <br /> t^E/ (952)249-4600 Amount: $ <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: ( q _1 0 -'- cQ • <br /> Owner: A vv\4+,- Af\.) Mailing Address: Vic-10 - F4.-.v. <br /> City: U v - o Zip: <br /> Home Phone: Alternate Phone: ;.,2 i I 7( .? 3s,"( 5-moo Z_ <br /> '711, <br /> Contractor/App.: 14c.,./ .5 .t S e-' Contact Person: 6"12-.47 <br /> Address: 3 State License #: L C <br /> City: i'i'1,7,-‘. Zip: 5'x"3(-03 Expiration Date: "z.c>/f) <br /> Phone: ") 3 -- Lf 7 5- Alternate Phone: /2 '- 6 g3- — y5-S-CD <br /> Residential ❑ Commercial ❑ Other <br /> $� "�' <br /> "�; ..� ;. ,�� a , � 4 <br /> New or Replacement System $100.00 / lU <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ / U v '-�=� <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />