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, '4 <br /> . � <br /> I � <br /> �O� City of Orono �� FOR CITY USE ONLY <br /> O P.O.Box 66 <br /> 2750 Kelley Parkway Date Received: Permit# Z%�6OGZL <br /> i Crystal Bay,MN 55323 N� <br /> (952)249-4600 Amount: $ . c�v <br /> � � <br /> Z�t, G� <br /> `qkE5Fi0�� <br /> CITY OF ORONO —SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Oificial) <br /> Job�����_� `"'"e�"J,nformation: <br /> _ . <br /> Site Address: �` �� � `L (�`� �C� ��� <br /> ` , _ <br /> Owner: �;� 1, � Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> ' Contractor 1Applicant Information: _ , <br /> pp.: �� ' � . V`t� . Contact Person: �,�, <br /> Contractor/A �( ;�i��`V1 f� s` �",.�.i� `� <br /> Address: ►2�'��� �e�'1,�� :� �l V �,t�1 State License #: ����(a',��2. <br /> , ��. !� <br /> City: �% Zip: � Expiration Date: <br /> Phone: _ ��;��'z� ,�1�� , �J�-�� Alternate Phone: �(�3•��G,�"l n l} <br /> � ' ' TYPES OF OCCUPANCY -�°�, <br /> , � _: . � � =� <br /> , � � � __ <br /> _: <br /> a -.} � <br /> � Residential ❑ Commercial ❑ Other <br /> ��� 9 k.�t�. . �, PERMIT'TYPE AND`FEES` �-.�,�:�;�;��� � >� �� 3 � - <br /> � - <br /> New or Replacement System $400.00 <br /> �f�U � <br /> r <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> �a <br /> Total $ ,�j <br /> 1 /2 <br />