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� <br /> O City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 <br /> I!J <br /> 0 2750 Kelley Parkway Date Received: /� L5 Permit# oZ�/S—��o� �� <br /> Crystal Bay,MN 55323 �0 G !1'� <br /> (952)249-4600 Amoumt: $ <br /> a � <br /> �F G` <br /> `�kESH�4� <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (All pertnits must be approved by the On-Site Septic Manager and/or Building Official) <br /> ,��b���'�tet l�t#�arma��on:' : �: � <br /> ��,�.N � <br /> Site Address: /�: ��-� f1 �,rC)1�f.�' !'� '(✓� <br /> r-� <br /> Owner: ��'�'t.✓�'� ��"%C'���'�=-=- Mailing Address: <br /> City: �t��� � �i",��• '� Zip: <br /> Home Phone: Alternate Phone: <br /> Con�r�e#or f A}���t l�fflrmation: <br /> . <br /> �. �--�� <br /> Contractor/A ��i;�:y� ���`� -'�� r r Contact Person: � �y����-I`� <br /> Pp• <br /> Address: ' �` �`�� �<����r/� �� State License #: �,�(J � <br /> � � <br /> City: ���.�/����'� �,,�� � ��Zip: -%��!.� �� � Expiration Date: <br /> Phone: `�-�1 —���� .�1 �� � Alternate Phone: l J l "�'� 7�` � �� <br /> ,; TYPE� 4F 4CGL1PiA��Y' <br /> � Residential ❑ Commercial ❑ Other <br /> : ?r: ;. PERM�T TY1�E AN� FEES : <br /> New or Replacement System $400.00 '��� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> Total $ <br /> 1 /2 <br />