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� F <br /> , ,,¢�� Clty Of OI'0110 FOR CITY USE ONLY <br /> � � P.O. Box 66 �,� 1� <br /> ��_.,. 2750 Kelley Parkway Date Received: J / �� Permit#�G�f l-C�`C`(P(t%_ <br /> ��'����`r � Crystal Bay, MN 55323 � �F <br /> �i�$o` (952)249-4600 Amount: S <br /> aeao$ <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 I Oui�n�`r�`nfarmatior�:���;� �#� ��°�� <br /> ,. �,�, � <br /> Site Address: ,-�`���(� j=nX SfrP�fi <br /> Owner. �C�.(�Ci,l ����>S Mailing Address: �`�� � ��C.�����' <br /> City: ��>1'�C~> Zip: J���� <br /> Ho��e Phone: Alternate Phone: <br /> �Contractor/Applican#=Informat�on ::; _�`��"'�` <br /> Contractor/App.: �?��y) �}��1��f-� �,�'Yr , Contact Person: �D� (� ���C� <br /> Address ������,?.�)C��C'�C�� l�� State License #: � 1 � � <br /> City: �' � Zip: Expiration Date: '�� , �/�� <br /> Phone: `��7�t —`-t`t�-'�0��`t Alternate Phone: /,/;;1--_����—�..�� <br /> ��'� � �.� TYPfS �F �CCUPANCY� ''��.�,����...�� �x ,� �� � 0.�� �� <br /> � Residential ❑ Commercial ❑ Other <br /> � � � � �� �rPE�RMIT TYPE AND FEES � ��"M����v . �.�-��.� �EG= .n�:'���� .� �. <br /> New or Replacement System $200.00 ���� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 <br /> Total $ ��,(�;� ,`�C-;; <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-14-11.doc <br /> 1 / 2 <br />