Laserfiche WebLink
� ' ¢�� City of Orono FOR C USE ONLY <br /> �, � P.O. Box 66 $/� l� Permit# p� //-0� �� <br /> � 2750 Kelley Parkway Date Receive <br /> � '� x�,�`� � Crystal Bay,MN 55323 <br /> �Y u,:°� � Amount $ �0� � <br /> '��o�$o (952)249-4600 <br /> 8 <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 / �wner ir�r�, �'" �� ,'" , `� �� `; ��4 <br /> Site Address: 2- � � `---��` ' � � `.�''i1 C�✓f i-`"� <br /> � � <br /> � � <br /> Owner: � U �'1� � C�-�� Mailing Address.� .5`��" <br /> � <br /> City: (� �' u�l'` � Zip: �"5-� S`1 <br /> Home Phone: Alternate Phone: <br /> tContractor/Appli�ar�tw��ii �`'�� *��''` " � '`a,' <br /> ��; <br /> Contractor/App.: • �S �� Contact Person: /'�-� (� <br /> Address: Z� � � � �+ S�� � State License #: �-�`��' �� `� <br /> �'_�_ /� ,L-�i�z_ <br /> City: �'��'��'2'� Zip: /� 5���� Expiration Date: <br /> Phone: �b � � % ��� / �� � Alternate Phone: �� Z � ��S j� v <br /> ���a.�... ''�J,,,#*� ������^���.. r����� k��Y�� � :V�§r �r���' �'�<< s' �S`, �'���,,, �^�Y� <br /> h� <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES `I <br /> New or Replacement System $200.00 Z�C.� � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> CJ`� <br /> Total $ Z-- L'� ` <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />