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I <br /> � <br /> O City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 C� , � <br /> � � 2750 Kelley Parkway Date Received: I�� IS Permit# L� (5`� <br /> Crystal Bay,MN 55323 qmount: $ �(�. � � �.- s <br /> (952)249-4600 i'lr.? y� <br /> � � <br /> yF . <br /> G <br /> !"�k£SHOR�` <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building O�cial) <br /> Job Site / Owner Information: <br /> Site Address: �Z D�� �f�� C r.�.l� A�- <br /> Owner: ��u-f�t ��^ $���d w- Mailing Address: <br /> City: �'rG-2� Zip: <br /> Home Phone: Alternate Phone: <br /> Contrac#or/Applican#It�fiormation: <br /> Contractor/App.:j=���J• P���r�c� �e Contact Person: ��^'� �!'a�e�'�'`��� <br /> C� <br /> Address: � �Z� �4�'�-c '�"t S� State License #: �� � <br /> City: I�Lj�^o Zip: s��4�- Expiration Date: <br /> Phone: � "l� � �-� 2`� 24 Alternate Phone: <br /> TYPES OF OCCUFANCY � <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES � <br /> New or Replacement System $400.00 T(%� � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> J�(/��j �� <br /> Total �`/ V v <br /> 1 / 2 <br />