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/�� City of Orono FOR CITY USE ONLY �� <br /> . �� . 0 P.O. Box 66 � �b �b� <br /> �y,�,, 2750 Kelley Parkway Date Received: �Z I Permit# 2� <br /> a� ''��;��,F�'. � Crystal Bay, MN 55323 <br /> ��,�=��� (952)249-4600 Amount: y <br /> c,,�,fi. ��,� <br /> �Ko <br /> pringste �� <br /> ^ A PERMIT APPLICATION <br /> I�v �J�-- ` ;Manager and/or Building Official) <br /> �(Y� <br /> �`s�,�t . , t . \ �\� <br /> � a`d <br /> 5 ,� � � . <br /> � J . � '�S <br /> � � � � �`'` � �. <br /> , � � Mailing Address: ��3YS �'� �,, iva <br /> �e��- . � <br /> Pu Ic Se tor Advisor:. <br /> -��� 800.236.30?: Zlp: ��Yvho.l�, /�n. SS`iK 7 <br /> � �� � � pringgtF�'.-,. <br /> Alternate Phone: g SZ"`{�Y- Z�t �( ( <br /> Conti�actor/Applicant Information: � ��� <br /> Contractor/A � ` <br /> pp.:���C' ��d�-:�,�.=i�. Contact Person: �t ,� ��� <br /> Address: j,��a����f�`�_� y'a�-��/C6� State License #: , <br /> City: �h��z ��_ Zip: �� Expiration Date: ;� Z /� <br /> C�%/ <br /> Phone: 9�� — �5�._S�7y3� Alternate Phone: ��.2��3� "//�y <br /> TYPES QF OCCUPANCY , <br /> :�. <br /> ❑ Residential ❑ Commercial �Other S�A SON11L —N��. �v�,,,�e �t� <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 � Zo 0 <br /> Repair Existing System 100.00 ' <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ Z o d, s o <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />