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. , <br /> ¢0� City of Orono R C TY USE ONLY /, (�� <br /> P.O. Box 66 ��,� � � nl�i Q `C y <br /> �' � 2750 Kelley Parkway Date Received: L-�. U Permit# (/� -� <br /> �i,�,� <br /> � "��'��'�' a Crystal Bay, MN 55323 >' <br /> � 1?��.�;�t�- � � <br /> a����.. �o (952 249-4600 Amount: �• v., <br /> t��.i(u�o$q, ) <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: Z Z �� �'��'�� ���� �"�` � <br /> Owner: ��� � ��� �������-2 Mailing Address: ZZs� �'��.��. �``� � <br /> City: ��'�J Zip: <br /> c��/ <br /> Home Phone: �1�2- Z�(�7 - � 7�U Alternate Phone: �'�Z `��'7�- `��Z� <br /> Contractor/Applicant information: <br /> Contractor/App.: N 5 �w-s Contact Person: �(Z�!� <br /> Address: �Z�3 �jZ �S'fS� � <br /> State License #: � �i�� <br /> City: ���n'��S-P Zip: ��>6,} Expiration Date: �� L � <br /> ��+ <br /> Phone: 7�`� ``�7�- �7�6 2- Alternate Phone: Co (Z C��S- �5�3� <br /> TYPES OFOCCUPANCY <br /> ❑ Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES ; <br /> New or Replacement System $200.00 ZC�%C�� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � Z �(� s� <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />