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�� 0 City of Orono FOR CITY USE ONLY <br /> P.O. Box 66 /, <br /> �4.,,,,.�� 2750 Kelley Parkway Date Received:�� !�9 Permit# �/ �� �� <br /> a ��'� �-"� �. Crystal Bay, MN 55323 <br /> z � �� <br /> �������',��o` (952 249-4600 Amount: $ <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 /> f r f�,� <br /> Site Address: �- '� �( ``� �,�� Y-C'�� �L� � �-� G�. �`C. L��. � <br /> r"��.,,G.v,v��.5 �[ C � <br /> Owner: I�.�J< {��:�,G,J ���U�, { v wC-t�• ,j' Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: � (L - `f��j - 5 I L � <br /> � Contractor/ Applicant Information: <br /> Contractor/A � <br /> pp.: �-� �W �'S �{ `Jn►^`� Contact Person: �d2�1� <br /> J <br /> Address: �-� 3 �Z `�- �� - $ �� State License #: �� � <br /> City: j�v�t>`St Zip: 5�3(c � Expiration Date: �-��, �� U i <br /> Phone: � (o � " t-( 7 5 - l �� "Z_ Alternate Phone: (� ( Z (� � `1S� <br /> ` TYPES OF OCCUPANCY ` � <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES ' <br /> New or Replacement System $200.00 �.- " '`-' <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ �� t� , scs <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />