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- 1 � <br /> 'p , City of Orono FOR CITY USE ONLY � <br /> �" ��' P.o.Box ss <br /> f� 0`�� � 'S Z4 I 7� �o I�-v `f!o S <br /> r, � . 2750 Kelley Parkway �1 Date Received: Permit# <br /> ��� Y,�'�r �� Crystal Bay,MN 55323 �q,.� <br /> '�� �� {�,c�� (952)249-4600 � Amount: $d�,!/� <br /> �k�o`� <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building O�cial) <br /> Job Site / Owner information: <br /> ,-_.,, -, <br /> Site Address: i��`�..5 � ��� ��r��'� <br /> Owner: ���;�. ��1���/�� Mailing Address: <br /> City: C�,��rC�%, %��/v .������ Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant lnfarmation: <br /> Contractor/App.:���'� � ����. Contact Person: r��- ���� <br /> � �a <br /> Address: /�'�� ��i� /�� State License #: ���,��'� � <br /> City: � �lle Zip: �C'? Expiration Date: ,/_�"frr✓ ��/_� <br /> P one: ��C,�� ��'l� ��,�C� ������� Alternate Phone: <br /> �.�� ` ��;�C� u�C�'� C�'���� � ��''ll��i l� /�`���� ���� �C'� <br /> TYPES OF OCCUPANCY � �/ <br /> , <br /> �sidential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 ���'"}• C�� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ C���. Z1 C'� <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />