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� . <br /> ¢�� City of Orono FOR CITY USE ONLY <br /> Q , � P.O.Box 66 ��o <br /> c��;;,, 2750 Kelley Parkway Date Received: � � Permit# �b ' <br /> � ��{��- � Crystal Bay, MN 55323 <br /> �����..yo (952)249-4600 Amount: $ �� .�� ��� <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 / (�inrner Information:- <br /> Site Address: 2 �" � � �--� � � � ' <br /> Owner: e-��'��5 � � �►^^e-'� Mailing Address: �-�7S ��K- S t• <br /> City: C) Ir�.c� Zip: .S�j 3 Z� <br /> Home Phone: Alternate Phone: (o �Z — Z S t —S "7 S� <br /> Contractor"/Applicant Information: <br /> Contractor/App.: �y-PS �a hs Contact Person: � ►2-�-� <br /> � � <br /> Address: �-�3 �'L 'Sf'- 5 � C8� <br /> State License #: <br /> City: /�I6 n'�"�'J� Zip: �3�3 Expiration Date: �--`� � � <br /> Phone: 6 3 ' `���t ' ( b Z--- �`�� <br /> � 7 Alternate Phone: ��2 � �.� %.5�,� <br /> � �� ��..��� �� `��`�� TYPES OF OCCUPANGY � � � � � <br /> Residential ❑ Commercial ❑ Other <br /> 4� �� �� �' :.� PERMIT TYPE AND FEES "`' "'' ' a�` °`` � <br /> � � � i �_:,� Y �,ilu�a., , g,�.� ,��a ,"��i�,a. a .. ���; <br /> . <br /> �. .. .� � �'� a . : <br /> New or Replacement System $200.00 � � U <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total � Z� � � <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />