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��� <br /> �"'" ���'` City of OrOno FOR CITY USE ONLY <br /> a' �� � <br /> ,,�� �� P.O.Box 66 a o„� o ►,o <br /> l(�;�,,4_, o,` 2750 Kelley Parkway Date Received: Permit# <br /> '� ���?� - ') Crystal Bay,MN 55323 <br /> \, � ,' .� c��f (g52)249-4600 Amount: $ <br /> ���' w•./ <br /> ���°$' ��a. � <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (Atl permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Job Site / Owner tnformation: <br /> s�te AddreSS: 2650 Fox Street Orono, MN. <br /> oWne�: Stephen Paulson Mailing Address: 2650 FOX Stl'eet <br /> c;ty: Wayzata Z;p: 55391 <br /> Home Phone: Alternate Phone: <br /> Contractor I Applicant Ir�����t�t�cin:���''��� � <br /> Contractor/A Burns Excavating, �tlC. Contact Person: SteV@ BUI'IlS <br /> pp.: <br /> Address: 3470 COunty Road 21 state �icense #: � 888 <br /> c�ty: Mayer Z�p: 55360 Expiration �ate: 3/2011 <br /> Phone: (952) 955-3112 Alternate Phone: (612) 685-4303 <br /> TYPES'OF OCGURANCY <br /> ❑■ Residential ❑ Commercial ❑ Other <br /> PERM[T':TY��'�►�1��FEES <br /> New or Replacement System $200.00 200.�� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 ---5:-69� •S� <br /> Total $ . a�D. 50 <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />