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� City of Orono /p�� FOR CITY USE ONLY <br /> 0� �0 P•O.Box 66 �'�" � � � � �p <br /> 2750 Kelle Parkwa �2 Date Received: d0 Permit# «�o <br /> i �t Y Y �. 51� �Z <br /> � ���1%�x•�. � Crystal Bay, MN 55323 <br /> ��'�,����oi��o` (952)249-4600 Amount: $ /DD• � <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 Infiormation: , ,� ��a��,� :� <br /> �� � <br /> �.� <br /> _, <br /> Site Address: .� �,�J 15,0, 1 s�>.���)r�5����� <br /> +-, <br /> �— <br /> Owner: /S,��SIc�� �,,,c;. Mailing Address: �� ��Y l�_�' ,�«zlS,�� <br /> r <br /> City: � �,�c:e jS,r,� ZiP� ��� 5�3� <br /> Home Phone: �c�v �/�-;/� �,��;� Alternate Phone: <br /> Contractor/ Applicant Information: <br /> Contractor/App.: �;,,; �,c��,,x�,�,n;_��c- Contact Person: �c. <br /> Address: Sl�y 2�� S f ��u�� �;5 State License #: ��; D� <br /> � <br /> City: ��-�,.����,-;<<.� ;^�1 Zip: � -D � Expiration Date: �0 %� <br /> Phone: �, l� �.f`lb `�l�'y Alternate Phone: <br /> TYPES OF OCCUPANCY <br /> (�C Residential ❑ Commercial ❑ Other <br /> ������, P�ERMIT TYP��AND� FEE'S �'��� � : ,�°�_.�� �. E �; � ,���'���� <br /> New or Replacement System $100.00 �DD.O�_ <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ (Q('.�� <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />