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,��� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 p <br /> ��.�,, � 2750 Kelley Parkway Date Received: ���`�J Permit#��9—O� �2—• <br /> `l>�t r� <br /> .��-,. � Crystal Bay, MN 55323 JrD <br /> �� ��'U'�:' , <br /> A,�t�wy�•$o (952)249-4600 Amount: $ /OD <br /> ���HpB <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 /> �� <br /> Job Site / Owner information: `��;;���q �""� ���� � <br /> Site Address: 'j i� �„% �j. C� T � l � � � <br /> Owner: � I G��'t jy" L- f1 A�� Mailing Address /�(t`'S i-�� (�?�(��' ��'�4 <br /> c�ty: �.� �� ��2 i� _� ,�- zip: �� S 3 �� r <br /> Home Phone:_ (s� � � - �� � "3:�S c� Alternate Phone: <br /> Contractor/ Applicant Information:� <br /> Contractor/App.: �.�c��N'`� F�� �( C',� �s'-d,'- ��,.��G Contact Person: L ��' �'' �4> ti' S <br /> Address: 3� �{ ,�`3 ;;h-}� � � ,�_S State License #: l.. ,�(c�f� �� <br /> City: � .- �c�a c.�-.� r�ti�Zip: ��,C;�f`i Expiration Date: (t-� --�� � � 1 <br /> Phone: �f� .� - �7 3 ' �(� �f`� Alternate Phone: <br /> � � � TYPES OF OCCUPANCY �� ��.,��� � ,; �`� ����d�' <br /> i <br /> � Residential ❑ Commercial ❑ Other <br /> � � �`��'PERMIT'TYPE AND�FEE�S ��� ��,,,� ������r�����,���,�� ';,�,' �� �� <br /> New or Replacement System $100.00 %C=' f' �' �% <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � '' + <br /> � C% Cl - � G <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 /2 <br />