Laserfiche WebLink
� <br /> r ' � <br /> ��� City of Orono FOR CITY USE ONLY <br /> /� P.O. Box 66 <br /> V 2750 Kelley Parkway Date Received: Permit# <br /> Crystal Bay, MN 55323 <br /> (952)249-4600 Amount: $ <br /> y� � <br /> �'�k�s}a o�-�. <br /> � <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 Fnformation: <br /> r \ <br /> Site Address: ��'7�i �"��K C Cy�-c f,� T�'�� <br /> Owner: �G�V f0•� V1iia �C h � l G� Mailing Address: <br /> City: o Y� �� Zip: <br /> Home Phone: 3�� ' 3�� " ��`� Alternate Phone: <br /> Contractor/Applicant fnformation: <br /> r -1 ,,l1 ) <br /> Contractor/App.: �'✓t,vGaj U ►'L � Tt�C. Contact Person: -J��t � k/t /l/K.c� <br /> — ,J <br /> Address: �-5(�7 � - o�Ci �- s�• State License #: o��G � <br /> City: �`� �'t��Zip: s��� � Expiration Date: 1 a �4 1 � <br /> Phone: y��� g�3"' ��� � Alternate Phone: �vja- Sl� � g'b 1 '� <br /> TYPES OF OCCUPANCY <br /> �Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> ��� <br /> New or Replacement System $400.00 , �?'� r <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Tota I $ �� � <br /> 1 / 2 <br />