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� ' ��' <br /> ` ' r ,¢�� City of Orono Fo ci u ONLY <br /> �, � P.O. Box 66 � �)� /y�^y � �� <br /> 2750 Kelley Parkway Date Received. J Permit !��/�� <br /> a �'���r� �. Crystal Bay,MN 55323 <br /> � ��' '� Amount: $ � Q. �� <br /> d�����Fo�.$o` (952)249-4600 � <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 Informafiion: <br /> Site Address: �I � / � �2 � <br /> � � > � <br /> Owner: �� �/i.� Mailing Address: �)� �i� ' �X� <br /> c�ty: ��^� �1� z�p: �3 31� <br /> Home Phone: �/-�� -�7�" .�'/f`6 7 Alternate Phone: �u� - 2�Q - �, �� � <br /> Contractor/ Applicant Information: <br /> Contractor/App.:��� �z ��, �,Z� Contact Person: G��-�n �G��2z°6� <br /> Address:j-�Fv:s'D �/�,�rj�` �1��G �� State License #: ,� ��y <br /> City: S�i ��=���� Zip: ' ,�.3 7 Expiration Date: ��-f Z�J ���� <br /> Phone: _ -�j'�:S L� �/��''7 i�3� Alternate Phone:rj� <br /> .. �/2 �Z3 L -��'�y <br /> TYPES OF OCCUPANCY � <br /> �esidential ❑ Commercial ❑ Other <br /> , �PE�RMIT TYP� /�NI] F�ES ,����� ������ �d;, �..��� '���,.,,,.�. <br /> New or Replacement System $100.00 /c��� <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � �d�;�C� <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />