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City Of Orono FOR715- <br /> USE ONLY <br /> P.O. Box 66 VT <br /> 2750 Kelley Parkway Date ReceivedPermit# <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ <br /> ye <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION 1 <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Job Site/Owner Information: <br /> Site Address: 00c) Willolo lvj Vl <br /> Owner: Uy&lAsa l K j n Wn Cil e S Mailing Address: <br /> City: n a y\-o Zip: <br /> Home Phone:Cj'�L-A70 - Cally ��� Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: �,t/G��y►�� � �,` Contact Person: -SZS R <br /> Address: 02 • �g" 000 1=' ST• State License #: ��D Z- <br /> City: Zip: SSD II Expiration Date: <br /> Phone: Alternate Phone: ee,t'�)- Sd t To l 3 <br /> TYPES OF OCCUPANCY <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES`' <br /> New or Replacement System $400.00 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) G � <br /> State Surcharge 5.00 5.00 <br /> Total $ <br /> 1 / 2 <br />