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¢�� City of Orono FOR CITY USE ONLY <br /> P.O. Box 66 <br /> �' � 2750 Kelle Parkwa Date Received: Permit# <br /> �;;.;;,. Y Y <br /> a '�'��•�' w Crystal Bay, MN 55323 <br /> m �y,�,,-- <br /> � ���; ��o� (952)249-4600 Amount: $ <br /> �'k;��'� �. <br /> ��08 <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: � C( 3 �� �'nJ �� ��1�. l Z �7. Ilf � <br /> Owner: l�.) i'r �► S�"� q � Mailing Address: ��I 3 �'c��,�J�l e � <br /> City: L.� A �( 2� r A Zip: � S '1 � ! <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: .1,�G(e S�� c�Q T',�es. �,�c��^G Contact Person: 3 C � � N I`�N g�elCo,M <br /> Address: L(�t�o t-E c...� �-1 SS State License #: � g� y <br /> City: L c��e-f�-1� Zip: 5535� Expiration Date: �-f - S -�o � o <br /> Phone: r ��0 3 ^ ���� � g� `� Alternate Phone: <br /> -, <br /> . TYPES OF.00CUPANCY <br /> �esidential ❑ Commercial ❑ Other <br /> � PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 0� b�•O� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ .2��• �� <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />