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�� <br /> Cit of Orono <br /> r, 1 FOR CITY USE ONLY <br /> ' �Q� '�� P.O. Box 66 " p ` �/ <br /> �'•,O 2750 Kelley Parkway A' � Date Received:�/�l/�D Permit b� 0�-�� � <br /> � 1`�li�.,�. �a <br /> ia n�- � Crystal Bay MN 55323 � � � � <br /> ��t tv;�:�.�, �, <br /> ��.���p4�o` (952)249-4600 � Amount: $ ��'� � <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 /> Scanned <br /> � Job Site / Owner Information: <br /> Site Address: � �f 5 I� �� r�j t c:�cz Ln �� � <br /> �� � .. . � . • ; T°��� e�..J e <br /> Owner: ���_.���>> �,�.�. : ��.� k .�� �,; �� Mailing Address: Cd`S �r';�c.���� 6� <br /> City: C� � ��,��� Zip: <br /> �a,�„ a s� �,��� <br /> Home Phone: Alternate Phone: � f Z �� � -�/5�-�^7 <br /> Contracfor / Applicant Information:��" �,§����`��"�w�� <br /> - ,�b.�,,.� <br /> Contractor/App.: 1-�u ��'� 'f ��^ S Contact Person: /Sr�'--� �� <br /> d <br /> Address: ' G= � � Z y' S�- S � - State License #: � �{ �' <br /> City: f`�1� E-� `' '{ Zip: `;`� ; �-3 Expiration Date: z_ �i o <br /> Phone: �� > Z-( l�J - /'�� Z_ Altemate Phone: �i z ^ �.�s -�i 5 s�> <br /> " f �,a��� �� �fi ���. <br /> � ' _ ���n��; ����`��,�YPES�C�'F OCCUPANCY � �. �� ;�: ��� � ,� � ; <br /> �;. <br /> � Residential ❑ Commercial ❑ Other <br /> �f'�...� �� ,, � �F: t,��..�.:�, �� �: ��'������'�;, , ,�P�'��t!I T TYP E AN D F E E S � ..,.., ,��..:.� ���,�x`' <br /> �_ <br /> New or Replacement System $100.00 �L � <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ / �� G �_` <br /> V:\(Permits)1Septic System Permit Application.doc <br /> 1 / 2 <br />