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��� City of Orono �R TY USE ONLY � <br /> P.O.Box 66 � _ >h// ^ � <br /> � 2750 Kelley Parkway DatE Receive • � perrnit#OlY/�K� <br /> Crystal Bay,MN 553 D� <br /> (952)249-4600 1v Amount: $ <br /> � � �� <br /> F G� <br /> lq'�ES H�4'�C <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 /> ,��rb������'�l��rrrr�ion: a,� �,_.:`;: <br /> Site Address Z�L`� �-� � ��+^ �- `� '�-� <br /> Owner: �� � � �L' �``� ( Mailing Address: � z�"S ���,� �s�--z <br /> City: �; ��v� i� Zip: <br /> Home Phone: Alternate Phone: <br /> Co���ctc�r�;}���t l�formati�n: <br /> Contractor/App.: �. �s t S--L. s" Contact Person: ��2-�-1� <br /> Address Z� 3 ���-`� 5� ��` State License #: �-- � '� � <br /> City: /`��h�`''�, ��'�- Zip: S�3�� �� Expiration Date: � Y /� <br /> Phone: (�. �2 � � �7S�Z Alternate Phone: �k� "`�7y� � �� � <br /> TYPES OF OCCUPANCY <br /> , <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT ?`YPE AND F��S <br /> � s6 <br /> New Replacement,�System $400.00 ���'� <br /> ���--- <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> i- <br /> Total <br /> ECEIVED <br /> AP� 2 5 2016 <br /> � � 2 CITY OF ORONO <br />