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r � <br /> , � <br /> 40� City of Orono FOR CITY USE ONLY <br /> Q � P.O. Box 66 <br /> I �,;,,, 2750 Kelley Parkway Date Received: Permit# <br /> � ��'�`r. � Crystal Bay,MN 55323 <br /> �a��,,�'��o��E (952)249-4600 Amount: $ <br /> e <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: �v� J ('�!i`-1 '�� 1 e j�� ,iv , <br /> Owner: /I/�.��w,� e J 5 o c� � �'/� Mailing Address: 7�.5 j=er���1� <br /> c�ty: t.� � �i Z� � �- z�p: �� 3`'( i <br /> Home Phone: Alternate Phone: <br /> Contractor/ Applicant Information: <br /> Contractor/App.: I�1 �.2�2C i��'_�'�.(��c,�J l� . Contact Person: �� � �3 � <br /> Address: State License #: <br /> City: l��' i A�v� Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF OCCUPANCY ' � <br /> ��; .� <br /> Residential ❑ Commercial ❑ Other <br /> - . , � . , � � ���PERMIT����TYP��A�VD� FEE�S <br /> New or Replacement System $100.00 <br /> Repair Existing System 50.00 S(� Bv <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ S� • J � <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />