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,��� City of Orono FO CI USE ONLY <br /> P.O. Box 66 �+ <br /> �' � 2750 Kelley Parkway Date Receive : � �� Permit#oZO�O"I�� ! � <br /> �'�t�:` �.� Crystal Bay, MN 55323 �� � <br /> 1�. tt�u;%' , <br /> Amount: $� — <br /> ��A��o¢�o (952)249-4600 <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: (� ���� � �� � <br /> ��� <br /> Owner: ���� 1L%r� � rlo��'a ti Mailing Address: <br /> c�ty: � 2d�v z►p: <br /> Home Phone: -�'� s� ' �13 - � �� Alternate Phone: <br /> Contractor/Applicanf Information: � <br /> � r,� �� <br /> Contractor/App.: ��A-�n��p� J�"w s Contact Person: '�o� V/�1 ^���� <br /> Address: �:��od IC� � �1 NUc�f��. State License #: �1 � �— <br /> City: �(0�5 Zip: 5��� Expiration Date: ��� Cl <br /> Phone: 7�� - `f 2�5- � ��,�_ Alternate Phone: (p(� � �(o`{-�S�O <br /> � � �� �� � TYPES OF�O�CCUPANCY � � � � � ����� <br /> ,� Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> Q`� <br /> New or Replacement System $200.00 ;j��(� � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 �- � .50 <br /> Total $ -�� , �� � <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />