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� r <br /> ,¢��\ City of Orono FOR CITY USE ONLY <br /> � � P•O.Box 66 / �7,, <br /> �,,.,�.,�, 2750 Kelley Parkway Date Received: �[�!�/-��Permit#,�[/7D� <br /> �� y����r�-,`�- � Crystal Bay,MN 55323 �� <br /> ��,��`����''1 � ���../ <br /> ���fH�¢�,o (952)249-4600 Amount: $ ��� <br /> CITY OF ORONO – SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager andlor Building Official) <br /> Job Site / Owner Information: <br /> Site Address: � � � r✓ � p c> %�-� h � �. <br /> Owner: ����� ;� .5�� �-���4�� Mailing Address: <br /> City: ����> �C� <br /> Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: � <br /> � � <br /> Contractor/App.: �—/�''`�� J - G� �-�' S�:2 ��? Contact Person: � ' 'r` ���`�e���'"`""'� <br /> Address: � I Z� �«� � �. /��r, S'� State License #: �Z�c� <br /> City: �e��:, c, Zip: � �,� 2� Expiration Date: <br /> Phone: (�4 3) %I 2- 2-�f 2�. Alternate Phone: �L'C�'< ZJ�- c�-�%�� ���' � <br /> TYPES OF OCCUPANCY ��� <br /> �,� ��a '�1 <br /> �� � � � � � �� �� <br /> � Residential ❑ Commercial ❑ Other <br /> PE'RMIT TYPE AND FEES <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 />