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r <br /> ♦ <br /> '� ¢��O City of Orono � � lt ; �fot�LY ,� , , „�',:;,;,�,;;i,: <br /> , <br /> P.O.Box 66 �J ����+ <br /> � 2750 Kelley Parkway �Daie'Receitratl: `� � Permit#' „��'�±.,�_t,�'�' <br /> , �,�„�;� <br /> Crystal Bay,MN 55323 ' � ; � ��,��, , ;�� f , <br /> � � (952)249-4600 ���� $ "' � , <br /> � <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 /> -:����.ite=��3�n�c I��ia��on�' ;.'" - . <br /> Site Address: 2-3�� `��nir� �� �.Jl�c� <br /> Owner: ��3e„�h T�`��\ �i..�e�r�� Mailing Address: �O� � ll� <br /> City: ��'o�� Zip: �J��Z� <br /> Home Phone: Alternate Phone: <br /> 'Cv�t�:a�+�r�;�I�p�i'��i�:f��'ma�in.. <br /> Contractor/App.: ��'ctir�, �c�.,,�, � �� Contact Person: J <br /> Address: rL��� ��� S'� . State License#: L�¢�'� <br /> City: `�-,rn��_ Zip: �,�� Expiration Date: <br /> Phone: (0 1 2— l� ��5- ��c5 C� Altemate Phone: <br /> -_ - . . `1�����3�'�t�,PAt�`Clfi' ,, _ _ ,�;�:... _ _ . <br /> esidential ❑ Commercial ❑ Other <br /> n'S� � - � ' ���,!! ��AF�:�ira�1�3Y�'!�'�'�El�J�..;'� - � _ ,� <br /> - ���� <br /> New or Replacement System $200.00 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> �� <br /> Total $ ���� <br /> W:\(Permits)\Septic PeRnit Application-Updated Surcharge 07-2&11.doc <br /> 1 / 2 <br />