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� - � <br /> . ,�0� City of Orono O CI USE ONLY <br /> P.O.Box 66 <br /> ' ��.t.,��, � I 2750 Kelley Parkway Date Received: � U Permit# � Q — �/Z""' <br /> �`\� ���yZfi,,-,r�. �.� Crystal Bay, MN 55323 —� <br /> �� '.i������$o (952)249-4600 Amount: $ �- �J <br /> ����HO� <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 /> Job Site / Owner.lnforrnation: <br /> Site Address: - � ��j��vy,��-'f��� j�o,�,�� �� �� <br /> Owner: ����6 G � . ����i� Mailing Address: <br /> City: �N�; ��i c•, Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/ Applicant Information: <br /> . <br /> Contractor/A � <br /> pp�� , �-���,����-`�,��_ Contact Person: ' � <br /> l � <br /> Address: �� ,go� � State License #: 4�� <br /> � <br /> City: j�h� c� i4 �, Zip: �-; ` Expiration Date: �j�N�h ���;/� <br /> Phone: �S� `�y�-� 5�5'� Alternate Phone: ���� c, ,� y ��J� <br /> TYPES OF OCCUPANCY � <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> ��;�,�.� <br /> New or Replacement System $200.00 ,:�L�C� .G7C <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />