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^ ¢0� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 af,t�4- O� �� <br /> • ��', � 2750 Kelley Parkway Date Received: Permit# ,Q/2LZ<'o <br /> � �`'{�-`r. C stal Ba <br /> ,� ,y���,,;f" � ry y, MN 55323 <br /> � �i�' w �o Amount: � <br /> ��,�`����� (952)249-4600 <br /> �H04 <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building O�cial) <br /> � � Job Site l Owner Inrormafiion;" �;�� �",�"` <br /> Site Address: �� �'�� � � � � T � �� �. `'J <br /> Owner: -�Q� G �- ���"�� �--�^ � Mailing Address: .3�� ✓�����<,2e:� �� ` <br /> c�ty: ��c � z� ���� zi s s� 3�/ <br /> P� <br /> Home Phone: `�S--��L��> ' .� v � 5- Aitemate Phone: �'�� '� ��L' "' ��� 3 <br /> C al��,s<� �se �-�.. � �- , <br /> Contractor/Applicant,lnformation ��, <br /> Contractor/App.'_ tir . Contact Person: � e� <br /> Address ��WS 7 �4��e s•f State License #: ZL 3 j <br /> City: Nn Zip: �► c.�"�7r Expiration Date: �� /— 0�' <br /> Phone: 7G�- ZE�c; ��!�C�_ Alternate Phone: �,�• LSG y�.� <br /> �, <br /> �,'��._-' �;a' "�„ -'�`� ��. ��� '�`w 4 ��,��s '� .�(� F�� ��g �.���' � .�sr.� "� ,.��.� v�c�+ <br /> ��F . w <br /> , .bs� _,v-::�' ....<� ..��� .�.."_.� �^I . 4� B,x,.. ,..,�* d F � .'xs+�F�'"+., ��s`�S�' �' '�- �d'"'-'"'fi$E?,�� .��'$f�� 5 <br /> �] Residential ❑ Commercial ❑ Other <br /> Sl'�-� Sc�,- `1- / <br /> �;����,.��r" �� x�`�.�� ���.f,� � ;� � P���ERMIT TY�PE AND �FEES � � � � ri.�� <br /> New or Replacement System $100.00 <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 /2 <br /> �� i <br /> ���'t/1 a�:, ;d �, ��� : ,�,� �L C <br />