Laserfiche WebLink
♦ <br /> + , 0� Clty Of OCOIlO FOR CITY USE ONLY <br /> P.O. Box 66 <br /> �� � 2750 Kelley Parkway Date Received:�a � /Y Permit# ��a—O/ 6� <br /> � ��x� r. � C stal Ba MN 55323 <br /> y�rt � ry Y� Amount: $��,OZ�J <br /> a� '.����.$o (952)249-4600 <br /> lvit�exoa <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager andlor Building O�cial) <br /> �� �ob..S�ite /�Owner anformation ' � �� � ����� <br /> � ..�#�'�: .-�Yd�a..:: <br /> Site Address: �� J � U C� � p/(� �`�� 1— '4�`� <br /> ---. �I, c N �. <br /> Owner: .�-�� �S O � S `J Mailing Address: S�� <br /> City: Zip: <br /> Home Phone: Altemate Phone: -j� 3 � 5 �-- z'�� � <br /> �Con#ractc�r�l�°� �;, ;�t�l nfo rmaf� � , ���F�. <br /> r , � <br /> Contractor/A .: �� �� �� 5'�5 Contact Person: l/ '`�' <br /> NP <br /> Address: 7� .S �7-� �'f' ��� L--� `-E C� <br /> State License #: <br /> City: �'1�•{�v s-e Zip: S�S �G� Expiration Date: ��� � � �`�L- <br /> Phone: 7� 5 ' � 7�I- �7,� � Alternate Phone: �'�2 ^��� ��'d `"< <� <br /> � a .� <br /> ,.,� ���,� $��1'�F������{���G�:1� �(��� �,� � ' � ��.�, ���� x. � <br /> " �� ���� -. <br /> Residential ❑ Commercial ❑ Other <br /> � PE RM IT��TYP�E AN D F E�ES � � �� �� ��� <br /> � J <br /> New or Replacement System $200.00 2-U v <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> � <br /> Total $ Z-v � � <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />