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� \, City of Orono oR TY USE ONLY <br /> �-��T�� P.o. aox ss v�� /.� 0�1J� ��J <br /> � 2750 Keltey Parkway Date Recei —1� Permit# <br /> � � Crystal Bay, MN 55323 <br /> � (952)249-4600 Amount: $� � <br /> .� �, <br /> i � <br /> y � <br /> F -� <br /> `��fStl�t''�v <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 /> Jab Site / Owner Information: <br /> Site Address: ��� C..���i S �;, � ��� / Ci%�C,,�� �,j���(/ <br /> �.�r�sr�� <br /> Owner: ��,4r.� �., ���Q� �tP S'ci.> Mailing Address: ���'�f�' �i�L � " <br /> w6�� <br /> c�ty: t�✓�4 Z �7�.� z�p: .�-� 3i, � <br /> Home Phone: �7�� — ,j�1��} �- �1���.� Alternate Phone: <br /> Contractor/Appiicant Information: <br /> Contractor/App.: �,�T�u� �- Sd���i� Contact Person: %� <br /> Address: ,� �� � � � /�2 Cd State License #: 3� � <br /> City: /�r-�-'Ak'r,� �i5�7'j"� Zi -; ���� Ex iration Date: � �' <br /> p: p' -' � / - � /� <br /> Phone: 3�U �� ���� � ��o�U Alternate Phone: ��,,7- ��S - /��f <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> , � � <br /> New or Replacement System $400.00 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5 0 �-�-�@-1 <br /> Total $ ��i"l� �� <br /> 1 / 2 <br />