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¢�� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 , <br /> ��;;t,.,,,, � 2750 Kelley Parkway Date Received: ( I Permit# �L��� J � I� <br /> � �'�-�. t Crystal Bay, MN 55323 ��i 4, <br /> ,����+��of (952)249-4600 Amount: $ � �i�`' /�/ <br /> u 4� <br /> aeso� <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--�! �� ;.� 5'f - <br /> �_, <br /> Owner: j�y-t..pr✓ .�l ���-- Y�.. u Mailing Address: ��4 +-��- <br /> City: d�iZ,'1�.� Zip: <br /> Home Phone: Alternate Phone: �S Z � ��� ' �� � � <br /> Contractor/Applicant Information: <br /> Contractor/App.: H�+��5 �-t-S��S Contact Person: ��a� <br /> Address: 7-� � ��`z''� ��- s � State License #: � 1v y�b <br /> City: ��y.+-Y�� Zip: '�'��� � Expiration Date: I i -� -��� <br /> i3r...j' c e � � <br /> Phone: 7� �3 - y � �� - � 7 k� �L- Alternate Phone: � f Z � C, v�' — �i 5�5Z <br /> TYPES OE OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES , <br /> New or Replacement System $200.00 Z-� �% <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ 2� .5` � <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />