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� ¢p� City of Orono FOR CITY USE ONLY <br /> Q - 0 P•O. Box 66 ,/ <br /> �;>.t.., 2750 Kelley Parkway Date Received?�� D f Permit#G���_� T'✓?� <br /> a '��'"t�f�_ �. Crystal Bay, MN 55323 <br /> �� '������y,�o` (952)249-4600 Am nt: $ <br /> �Ra�sxo4`�' <br /> 'l'�$�p�1 <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: ,��%`}v �v � (,���- % <br /> Owner: .S (�.N� w��,,� !��51G--� Mailing Address: ��t� � (,(j�a�zrt'� (,3L���. <br /> City: �l �.�.,��-r��o�l,�=� Zip: SS�f�� <br /> Home Phone: ���� -L `I 7 - SS%�; Alternate Phone: �;S .- �_S� -- �77.3 <br /> ContractorJ Applicant lnformation: <br /> Contractor/App.: ,'�l+I N�✓� � �J�� S . Contact Person: T�^'� <br /> Address: �3�d� 1 U� `� /�� State License #: �1 s <br /> City: (,-�,��5 Zip: �-SS 7 � Expiration Date: ' C�jC� <br /> Phone: Cvl -� - `���4- -�S/C� Alternate Phone: �7�,� -�{r��-7�y3 <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> ���°�� �� ,�,� ��� ,,�� ,.������� ��� P�ERMIT��TYPE AND FE�ES ��� ���� � �w,;,�������� ���r� ��_ <br /> �� ��� <br /> New or Replacement System �.98'CIt� �� . `'`' <br /> �e��•U� <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � �. �(� : �(� <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />