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¢0� City of Orono r/ FOR CITY USE ONLY <br /> � � P.O.Box 66 Drj / <br /> c�,,,, 2750 Kelley Parkway L�'�jv Date Received: J�� � Permit#�� <br /> � ��y'i��. � Crystal Bay, MN 55323 J <br /> � ',��������.�o (952)249-4600 Amount: $ loD.�D � � � <br /> �A�Ko <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: <br /> Site Address: / �,C C� J��� � �/�,N Drr��� Iv, <br /> Owner: ���rc4�z� �r,c�sa�� Mailing Address: <br /> City: Zip: <br /> Home Phone: Afternate Phone: <br /> Contractor l Applicant Information� <br /> Contractor/App.: >�;.�, �X«, .;/,c:,, fi S co�•c Contact Person: r� <br /> Address: �C�y,� � Jf %�wJ ;;SJ State License #: '��0� <br /> , <br /> City: �k��ir;a,,, �'In; Zip: �(C�y�f Expiration Date: �D// <br /> Phone: (.,/'�- ��d �- �/�`� Alternate Phone: <br /> �� � TYPES OF OCCUPANCY wpa,, „n„y,, �° � "�'�_� �� <br /> �; �� �� <br /> [� Residential ❑ Commercial ❑ Other <br /> ;� ����PERMIT�TYPE AI�@i��FE��� � � � � ���' ������� <br /> � , <br /> �. � <br /> New or Replacement System $100.00 �DO• �� <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � l��_ ��j <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />