Laserfiche WebLink
� ¢0� City of Orono FOR CITY USE ONLY <br /> � Q � P.O.Box 66 r r ", ' !'}�.,> , <br /> .�cL�' ._ 7�- <br /> � �, 2750 Kelley Parkway Date Received: J f%/ C�' Permit# ' <br /> � q����;��- � Crystal Bay MN 55323 � ��� � <br /> ��f�,��w��.�o` (952)249-4600 Amount: � � �-y���� <br /> �y�xo4 <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 I Owner Infiormation:;r�� � �� ���.. �' � <br /> �s, <br /> -- � — <br /> SiteAddress: ��1� ��, '(,,���� <br /> , N� � <br /> Ownpr: ��� ��'�l� Mailing Address -���a' '��.� � <br /> ) <br /> c�ty: ( �O z�p: <br /> ���� <br /> c�� � � �i°� -c�'U� - <br /> H�rfe Phone: � Alternate Phone: ���� <br /> Contracto =Applicant Inf :����`""� �-, � <br /> �LL;� ����'�'�11�7�1 � <br /> Contractor/App.:_�/���,�,,1'�'� Contact Person: � - <br /> Address ���1� ���,� � State License #: � �� <br /> City: '�l Zip: ��7 Expiration Date: � �(�' <br /> Phone: l 1��� C���J" `-��� Alternate Phone: ` <br /> , , <br /> � <br /> ; ,z�,s � ,m� � �, �.x�.� ... �R;E'� O�' �C�P14NC , � "r��� `� <br /> ,. <br /> � � <br /> � , <br /> Y , <br /> � . �: ,... . ... «. �, �.� <br /> , , � <br /> ,�_.. ,�,�� . , ,� . .�, ���'��.�:,, <br /> esidential ❑ Commercial ❑ Other <br /> ry ,���;�� k,�j�� � >�r��, aa��.����� :;..� ' PERMI�":TYPE AND FEES � <br /> New r Replacement System $100.00 f�:1�, � �-' <br /> Repair Existing System 50.00 �— <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />