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00 Orono <br /> FOR CITY USE ONLY <br /> P.O.Box 66 <br /> 2750 Kelley Parkway Date Received: Permit# <br /> Crystal Bay,MN 55323 bpd.SO <br /> (952)249-4600 Amount: $ <br /> RECE-11 FED <br /> OCT 0 2 2008 <br /> CITY OF ORONO -SEPTIC SYSTEM PERMIT APPLICATION CI7YOF <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) ORONO <br /> Job Site I Owner Information: _L <br /> Site Address: L4OS W i I Ioy: S` ete 1 <br /> Owner: 7r i Jdanal rl Mailing Address: LA 05 W i It r)VI) (S+. <br /> City: Ornnn Zip: <br /> Home Phone: 9Jo�-�7�- �J�7 Alternate Phone: <br /> Contractor/Applicant information: <br /> Contractor/App.: olcin ( n,4 po..aw_ • Contact Person: own n <br /> Address: torr)lPW State License#: Ll I I <br /> City: Zip: �� Expiration Date: ljj . e S AM <br /> Phone: 676Y- 4/49-66 <br /> 34 Alternate Phone: Cy I -A�fl'14 `{O <br /> TYPES OF OCCUPANCY <br /> Residential ❑ Commercial Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $100.00 100, M <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ <br /> V:X(Permits)\Septic System Permit Application.doc <br /> 1 /2 <br />