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1 <br /> � ��'�, City of Orono FOR CITY SE ONLY <br /> � N � P.O. Box 66 �-j J" ' <br /> � ` 2750 Kelley Parkway Date Received: lt�� Permit# � ���� �/ � /( - -,. <br /> � Crystal Bay,MN 55323 L.� �,�T 1 <br /> ! (952)249-4600 Amount: $ /D-�!VV <br /> � <br /> , ,�' :� <br /> ����E�S}�{1���� <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: rL-`�� � �-"�S� � �2A--f �— <br /> Owner: �� G�••1 ,�� � � 5 Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/A .: 7� •� 5 � �*n-5 Contact Person: ��-�� <br /> NN <br /> � <br /> Address: Z� 3 �'2-� 5"t S �'� State License #: � tv `� C� <br /> City: /���''�� Zip: Expiration Date: �-� Z-�i S� <br /> Phone: � � Z �� �-�� � r� Alternate Phone: �b 3 r��5 � ��6 Z- <br /> TYPES 4F OGCUPANCY <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $400.00 • / � U <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> , <br /> � <br /> Total $ �� S � <br /> 1 / 2 <br />