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® V0 <br />City of Orono FOR CITY USE ONLY <br />P 0 Box 66 <br />2750 Kelley Parkway Date Received. P"mit# 4 . Z_ <br />Crystal Bay, MN 55323 <br />(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 />Job _Site _/ Owner Information: ❑ <br />Site Address.- ii -i 13cc <br />Owner: Mailing Address: <br />City: On' �­10 Zip: <br />Home Phone: Alternate Phone: <br />F _co`ntrac�tor/ Applicant �Info�rmati6`n.� <br />Contractor/App.: <br />Contact Person: <br />Address: <br />State License <br />City.- zip: Expiration Date: <br />Phone: 2 63 `122 - 2? 2,e7 Alternate Phone: <br />TYPES OF OCCUPANCY <br />Residential El Commercial ❑ Other <br />PERMIT TYPE AND FEES <br />New or Replacement System,,/ $400.00 <br />Repair Existing System 100.00 <br />(Tanks or Drainfield) <br />State Surcharge 5.00 5.00 <br />Total <br />$ <br />1/2 <br />