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07/09/2068 1�:37 952-955-5071 BURNS EXCAVATING PAGE 62 <br /> ����� <br /> �fl� City of Orono � ; � ;FOR�1T'f' S�LY <br /> P.O.Box 66 <br /> � � a�r�n�t# � <br /> d 2750 Kelley ParKw2y '�������'� <br /> O�' 'r t Crystal Bay,MN 55323 ''1{''� a i., ' <br /> ���b`- (952)249-4600 ��1�y�Vl�ti1�'l� „":$�d�i�=��� <br /> , , <br /> � „" <br /> ����-D�G'��' <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits musl be approved by the On-Slte 5eptl�Mena9er andlor Bullding Offiolal) <br /> ,�d ,,� �r,� �m <br /> �, I.; �'J�r.��''��+, �#�°d�`a��`�'y��'�� ��c <br /> � ti <br /> Site Address:_,_`�I�S ��Ill�'�I4LL� �Db� J�1d27� <br /> Owner: S/�f��J f7DL'S�� Mailing Address: Ll� ��l16QL� �C� �' <br /> city: �f�Gllla Zip: ���'9/ <br /> Home Phone: L7�3� ���9 ' �lo�7 AI#ernate Phone: �7�3� ZyS -q�q"7 <br /> �,, <br /> i' ' � ' <br /> Contractor/App.:_,�GC1ZN5 �L_'.69116471�G;��f.0 Contact Person: ST�II� ��(Z11s5 <br /> Address: _ �l�� �CGI/�1T�/ �Gd� ZI State License #: ��$ _ <br /> City: G Zip: _5 S.3�C5 Expiration Date. �'1�I��Ch� Zl, ZC� <br /> Phone: ��'SL� cl.S��I/Z. Alternate Phone; ��0`2 ) ��SS�3d� <br /> , .� � � � <br /> ;l^'. I ' � ; ' <br /> � Residential ❑ Commercial � Other <br /> �{ �' � . i �1 � ���, <br /> New or Replacement System $100.00 , /L�b� � <br /> Repair Existing System 50.00 � <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total GG• � <br /> v�1(Permlts)\SepUc System Permlt Appllcetion.doc <br /> 1 /2 <br />