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� . <br /> g�� City of Orono FQR CITY USE ONLY <br /> �:r, � P.O. Box 66 �•��7 d ��'�''1�- ����-- <br /> �,,,., 2750 Kelley Parkway Date Receive Permit# <br /> a ��'�'��; .. Crystal Bay MN 55323 �-7� <br /> � t,L;';�" ,� Amount: $ �0�.J � <br /> �^'�(,���;.��F��$o (952)249-4600 <br /> ��a9H� <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 lnformation: �� 4�� : ' <br /> Site Address:_ � ��� C�i,P�p-e.w A- �� <br /> r---- <br /> Owner: � u� � �o��E Mailing Address: Lf 35�� ��,'��E��„�y �-�-' : <br /> �� <br /> City: /�G� � ������. Zip: 5 S3�/ <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information �.,� <br /> Contractor/App.: �. -25 , '�s Contact Person: �-� <br /> Address 2�= 3 ��2�� S�� S� � State License #: � �� <br /> c <br /> City: �°'�fi�v� Zip: S'`� 36� Expiration Date: �C_ � <br /> Phone: � G3 — �{`7 � � l '� � `Z �t � ,� <br /> Alter.�ate-�.hone: L-P (2 Co � �r S� <br /> � °' � � ����� TY�E� OF OC�CUPANCY <br /> �esidential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 <br /> _....__ _ <br /> Repair Existing System � 100.00 /��•� <br /> ks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � �� G <br /> �� <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />