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�p�, City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Q Sf�� <br /> . '� � 2750 Kelley Parkway � Date Received: Permit# ���a r <br /> a �` �- � ' Crystal Bay,MN 55323 _/a ,�f� <br /> �� '•'�� .bc. (952)249-4600 V� Amount: $�� �/� <br /> ���� V <br /> �� �r <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 /> ,, <br /> Site Address: ��� �' �'��-'���� ���� <br /> Owner: � ����� � Mailing Address: �� v�� �""�" <br /> City: �✓ Dn U Zip: �S.3J�� <br /> Home Phone: �S� � ���� � �� �� Alternate Phone: <br /> Contractor/Applicant Information: <br /> I/ �I,,� ` � �U�• �/�f�" <br /> Contractor/App.:�1'1 (�'t'►`�V"CiG�i���r,�,U,�Y+�G� Contact Person: �.1NYl I`�W►°1��� <br /> Address: ���iS� ���� �n , <br /> State License #: �'1'l��C',i4 l���(� <br /> City: U� Zip: �3 " Expiration Date: `fi'���� �3 <br /> Phone: ���' `t"����� / � Alternate Phone: <br /> � TYPES OF OCCUPANCY <br /> � <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 � �GU� � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ L� � S'/G� <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />