Laserfiche WebLink
,¢p�, City of Orono FOR cinusE oN�Y <br /> 0,e � P.O. Box 66 <br /> �� 2750 Kelley Parkway Date Received: �:�B'��permit#z�g'O� / <br /> a �t ���``'. � Crystal Bay, MN 55323 <br /> �'����,.,.f <br /> l ���04$0'` (952)249-4600 Amount: $ l B� 3-� <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: :�w���� <br /> Site Address: �' '�(� �; (r 'f"S ( (�.�. C� <br /> Owner: ���. � ��'�`T /1/t/�� j �A/l� Mailing Address: ��,7 � �j�� �-i��M- � i�'� <br /> c�ty: �� � v�c� z�p: ��'� 3� `� <br /> Home Phone: �- �� -L� � � m I 7 G C% Alternate Phone: <br /> � Contractor / Applicant Ir��fi�����i�a�'°��� ����"�`�`�_ <br /> Contractor/App.: 5C> ti� i''�t�1�,� �.�-f: G Contact Person: Cr <<%C� ;o�;,S <br /> Address: ��G�y'��3 5�� �1 �+� i—��..� �� ��' State License #: �- ��G � <br /> City: L 1 f'.1 c��z.f�ti3 Zi � � ���`�`� <br /> p• Expiration Date: �� v� �•�`� � <br /> Phone: � J � "� �3 `" �� �`�( � Alternate Phone: <br /> �. <br /> '������ ����s �`����������.��` ����P�ES�� �����?, ���'°����� �-� �;e ,�� <br /> , <br /> Residential ❑ Commercial ❑ Other <br /> '��� �;��.� f �,�. -�� � ,nf�.:'�����.n�{ P.E�,RM IT`��(P E AN D F Ef S ��� � "'�� �4° �`' -� <br /> � � <br /> New or Replacement System $100.00 �c� c; - � �- <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � ��, . ����_ <br /> � /�. <br /> V:\(Permits)\Septic System Permit App;ication.doc <br /> 1 /2 <br />