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r <br /> O City of Orono FOR CITY USE ONLY <br /> P.o.Box ss ic 'g <br /> � � 2750 Kelley Parkway Date Received: !� Permit# �61�"n1 <br /> Crystal Bay, MN 55323 � <br /> (952)249-4600 Amount: $ ��� <br /> a � <br /> yF � <br /> G <br /> tq kES H��� <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION � <br /> (All permits must be approved by the On-Site Septic Manager and/or Building O�cial) � � <br /> � � � <br /> g� I <br /> Job Site / Owner Information: <br /> Site Address: ��- � ��' ��� f�' � t,�_� /,� �� � <br /> Owner: Sv'S�r �-�r � �•� Mailing Address: <br /> City: �!`� � �' Zip: <br /> Home Phone: E � � - ��' � ' �� y�^� Alternate Phone: <br /> Contractor I Appficant Information: <br /> Contractor/Ap .: �« ��h�.lr ���� t/���'� Contact Person: Y� � ��, '� ��:� ��l <br /> p <br /> Address: � ��%/ C-�:-��'��' ��� - l�� r ' State License #: �- .���' �'_� <br /> City: S"�- ��� ���- � Zip: 5�3-3�,� Expiration Date: <br /> Phone: � C� ' `l/% - o �/�- Alternate Phone: <br /> TYPES UF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> // � <br /> New or Replacement System $400.00 7"0� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) � <br /> Total $ �� <br /> 1 / 2 <br />