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� Og��O City of Orono FOR ITY SE ONLY <br /> P.O.Box 66 / �y/� n <br /> �;,,,, 2750 Kelley Parkway Date Received:/� b � Permit#�lvld v� �� <br /> �, �'�x,. Crystal Bay,MN 55323 ,t^ (`j fl <br /> �9��1�'�' � �J/ <br /> ��?�����o (952)249-4600 Amount: $ � <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION n <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) '� , '' D� I� <br /> 1� ( <br /> ��Job Site�l{�u�i�er fnforrnation: ���� <br /> � �,�,� <br /> .. t� <br /> Site Address: � ��G� �f �x `�-� <br /> Owner: ����;� ���.c ��{^ ; Mailing Address: :�� 2c�j �e� ��. <br /> City: L an1c, � ��l � Zip: ,;� ��� <br /> Home Phone: q�c ' `��7 3 � � 7 �'�`> Alternate Phone: <br /> Contractor/Applicant Information: � ' _ <br /> � ��� <br /> � l� �! � /� <br /> Contractor/A . �� � �� �.�`� I� r��� Contact Person: ��J� � c�-�--< <-� <br /> P P � � �< <br /> Address: State License #: �`'� � <br /> � c �- <br /> City: �(r� r " "�,�-Zip: � _>� �=�`7 Expiration Date: � <br /> Phone: t�1o3 �{`?�j Isu-7 Alternate Phone: (,: I Z y 1 G v 7 �� i <br /> �"� ' ° ' TYPES OF OCCUPANCY �`�"�"'"�" <br /> a <br /> e,� �;. <br /> � � � �. � . , . <br /> � <br /> � �� _ � � �� � � - <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES � ' <br /> _ ___ _______ <br /> New or Replacement System/ $200.00 ��G� �� <br /> --------� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ :��� ��'� <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />