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r : � / <br /> AV <br /> , ,��� City of Orono C �g�� � FOR n u o Y n <br /> � � P.O. Box 66 �� � � �� /�/�� L) <br /> 2750 Kelley Parkway Date Received. rmit#T� � <br /> �a �'� �;:rr. � Crystal Bay,MN 55323 s � <br /> ���(��,��y+��o` (952)249-4600 Amount: $ ��C , <br /> �ggg0 <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 /> � � <br /> Site Address: �. �' �� ������n- „��2-�-Z.--�. <br /> �) <br /> Owner: ,,��_��� �,�7 �� r-G�� Mailing Address: <br /> � <br /> c�ty: � ��-��-�- zip: � 53 s� <br /> Home Phone: Alternate Phone: <br /> Contractor/ Applicant lnformation: <br /> �� <br /> Contractor/App.;;������=������-�> �� Contact Person: j�ic°�-�- //c� <br /> , � � " Z <br /> Address �� 2 c� ��-��� .�� State License #: � ��Gf � <br /> City: �i� �� ����Zip: � �� �� Expiration Date: _�� 2 3 -C> � <br /> Phone: �� 3�-�f �� � ��f- � Alternate Phone: �- �� `���'��L / <br /> :' TYPES OF OCCUPANCY �� <br /> � Residential ❑ Commercial ❑ Other <br /> ����� ����� PERMIT TYPE AN��D� FE��S �� � ,�r <br /> � <br /> New or Repiacement System $100.00 �Q(7 <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> , > o <br /> Total $ �'���� ��� <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />