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�0 City of Orono IrGIF uSE �tt1� r <br /> P.O.Box 66 <br /> 2750 Kelley Parkway Date#Recetueci Permit <br /> N � Crystal Bay,MN 55323 <br /> 6 ` <br /> (952)249-4600 <br /> resoe <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 /> Owner: Mailing Address: c� — <br /> City: 0�����-�— Zip: <br /> Home Phone: 7-5 -J l/ 9 Alternate Phone: <br /> Contractor/App.` ��r �z Contact Person: <br /> Address: 772 -�" � - State License #: <br /> City: Zip: S Expiration Date: 0 <br /> Phone: 7b L74� Alternate Phone: Ce f Z -/7; / <br /> lq6 <br /> Win <br /> WE <br /> . .. <br /> Residential ❑ Commercial ❑ Other <br /> s <br /> New or Replacement System $100.00 ��d �- <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ la o e SU <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />