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1 . <br /> ,�p� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 C/ <br /> ��.t,.,,, � 2750 Kelley Parkway Date Received: ��/' O� Permit#�' ��S� T <br /> � ��y�-.� � Crystal Bay,MN 55323 �� <br /> ����'�%M1p4�o` (952)249-4600 Amount: $ S� -� <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: � j � �' �^ � :�, ` � <br /> Owner: Mailing Address: <br /> City: (�' ►��� �. �-:, Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/ Applicant Information: <br /> r <br /> Contractor/App.:_ f_--�r+�ti ;_,t � .- A t GC� , Contact Person: � '. �- �� ' `���r� �, <br /> Address: J `%" � � Qc,�. �.� r s!,�d.�'�' S'f State License #: „2 � J <br /> City: �.�: �c. � ,�, Zip: � `� ,�2� Expiration Date: <br /> � r. ,. r r�. � <br /> Phone: � ��� �� ,�� � . � "' Alternate Phone: �wc;•��,� '" � ,.5`;' <br /> � <br /> '`" TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES ' <br /> New or Replacement System $100.00 <br /> ��� Q <br /> ���epair Existing System 50.00 ,5�: Dd <br /> ��� (Tanks or Drainfield) <br /> `State Surcharge .50 .50 <br /> ��Total � � .� <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />