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�O� City of Orono F R C USE ONLY <br /> P.O. Box 66 �jyls D� <br /> � 2750 Kelley Parkway Date Received: � � Permit4�'1� <br /> Crystal Bay,MN 55323 �i � � <br /> (952)249-4600 �� �I Amount: $ <br /> �� � � I <br /> �AxESH���� �� ������ � <br /> CITY OF ORONO — SEPTIC SYSTE PERMIT APPLICATION <br /> (All permits must be approved by the On-Sit�Sept c Manager and/or Building Official) <br /> Job Site i Owner Information: '' <br /> -7 _ <br /> i A ress � � S� ?J� � <br /> S te dd r ��--� <br /> � <br /> � <br /> Owner: �Y �-� �,l�� �'�. Mailing Address: �/�5�� I�c.=..�S� 1``�' <br /> City: �;,GYf��% Zip: ��3 S`'�I <br /> Home Phone: �'ls�Z �7� `��jU Iternate Phone: ��Z �� 7 7C��;� <br /> Contractor!Applican# Information: '�, <br /> Contractor/A .• � ' "' " ..5-•h S ontact Person: �/2�17 <br /> pp � <br /> r�✓ <br /> Address: �i � 5 �� ��� . S� tate License #: L--�% �� <br /> City: /�U�fi''�� Zip: ��,� 5 xpiration Date: /L � / � <br /> � <br /> Phone: ?�S' ���� � �� Z- one� �i Z'� �`j= `��� <br /> TYPES OF OCCU�'A CY :. <br /> Residential ❑ Commercial Other <br /> ; <br /> � PERMIT TYPE AND F ES <br /> , <br /> New or Replacement System $400.00 � CJ � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> � <br /> Total ��✓ � <br /> � <br /> I <br /> 1 / 2 <br /> i <br />