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" Cit of Orono � R CITY USE ONLY ��� <br /> :'��'�'��'� P.O.Box66 �a7/(� �p� /0- <br /> ' Date Received: � Permit# <br /> f Q,; � .`� 2750 Kelley Parkway <br /> ;, i�����-� ��� Crystal Bay,MN 55323 ad��� <br /> ��� '� '�� o��� (952)249-4600 Amount: $ <br /> \�� o��// <br /> ,. aa� .. <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: z�/Ul� ��X 5 T��1 D 120IV(� _ <br /> Owner: �1>,� �C1= L./ti1��5'%l L1�-�J Mailing Address: ZL�G/l� /�l�/�U�'3/ ���C� <br /> G <br /> c�ty: a��nr� z�p: s^s:� � / <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant lnformatian: <br /> Contractor/App.: � �i2�tl� Lxc��Uv�T7kT, .�i�C- Contact Person: ���1/(! �Lt/�N�. <br /> Address: 3�1� ) L�G�1�.irV 1����'l Zl State License #: � ��� <br /> City: �1l� �/� Zip: 55 31�U Expiration Date: 3 � Z��Z�l � <br /> Phone: �7S z� C.5 S "�3// � Alternate Phone: �Lf/�J �1�� -y3� � <br /> TYPES'OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> _ PERMIT TYP`E AND FEES ..: : :. <br /> New or Replacement System $200.00 b� ' G� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � ��v ,� <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />