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�s• <br /> City of OrOno FOR CITY USE ONLY <br /> �0�0 2760K elleyParkway Date Received: �� Permit# a���l' —0 33� <br /> Crystal Bay, MN 55323 p <br /> (952)249-4600 Amount: $�D .0 <br /> a � <br /> 2 � <br /> L� <br /> �`�kfSH��� ��/� /�'� � �_� <br /> �� <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 Information: <br /> Site Address: <br /> SG S ���c,,��aL� �v�. it/- <br /> Owner: � A-2� �c.�`(� Mailing Address: � '/�S� �c�t.� S��zR� <br /> IS '�v S . �� `""- <br /> City: Zip: <br /> Home Phone: Alternate Phone: �G� 3��� �5�� <br /> Contractor/Applicant Information: <br /> Contractor/App.: <br /> ��NU(�� �- � 6NS Contact Person: � �- �M��� <br /> Address: 0�3 v� � O q � �-t C,G State License #: � � s <br /> City: p �c�- Zip: s�3� � Expiration Date: J�� �3 <br /> Phone: ��3 ' �a g - 7 3 y 3 Alternate Phone: �/a- 1� `�- �S � U <br /> TYPES OF OCCUPANCY <br /> �Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 ��� �� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ � OS, ��' <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />