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� il ����7� � 4�� V:C1�"N�1•'�N tH� <br /> (� <br /> . <br /> �O� City of Orono � �n FOR ITY USE ONLY <br /> � 2750 Kelley Parkway Date Receivec��� Pertnit# OIC�f � J/o'—' <br /> Crystal Bay,MN 55323 �� /t-, <br /> y � {952)249-4600 � �„` a 1'J Amount: $ Q� � <br /> � L� ������� <br /> lqk�SNOQ"� <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 ��� 3 ; � �,Zr- � �,,,,� `(-�.;1 ��,S �� <br /> Owner: �y �� �-��*��+�.} Mailing Address: <br /> City: ��IL 1�;�.z. Zip: <br /> \ -�. '` <br /> Home Phone: � ��� �► �� - '`�`'� � Altemate Phone: <br /> Co�tr�ctor/Applicant Inforrnation: <br /> Contractor/App.:_-5<���`'^ � � �Q����� - �X G� Contact Person: ���,������ �'�Q�� <br /> �a <br /> Address: �� � vi1� +�� ����� � �"V `�' State License#: `��q <br /> C�tY� �`'-� '�''�r Zip: �� Expiration Date: 3- `Z " � •� 1 l�'' <br /> . <br /> Phone: ���� � �'�3�- 3 �'��' Alternate Phone�M `,� �- `��`�- �U�� <br /> TYPE� 4F OCCUPANCY <br /> ��] Residential ❑ Commercial ❑ Other <br /> PER�AIT TYPE AND FEES <br /> �'�le or Replacement System $400.00 <br /> �DO �a <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) � <br /> Tota I $ ��D <br /> 1 /2 <br />