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O City of Orono FOR CITY USE ONLY <br /> � � P.O. Box 66 C� <br /> 0 2750 Kelley Parkway Date Received: Permit# �(3^ 3 ` <br /> Crystal Bay, MN 55323 M-� <br /> (952)249-4600 Amount: $ 'v�/ <br /> a � <br /> y � <br /> F �` <br /> �qKfSHO�� <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: 5S ���-t�� ��ew ��l � <br /> Owner: V � � ���` �_������'� Mailing Address: � �l�til Ul�(-c� � <br /> city: a�2 z�p: S 5.35,� <br /> Home Phone: Alternate Phone: �5�-� �5�`�fJ <br /> Contractor/Applicant Information: .� � <br /> Zu � .��'�'� � � <br /> Contractor/App.. ��l �' � (.�� <br /> ' � � , I��I ���,Q, , <br /> Address: l�,S�j� l��-V� �,Q., WV �`"C- �'�Vv� /J(�' � <br /> �� " � ,(�' <br /> c�ty: �' z�p: S 3 I � _ � - l� <br /> Phone: ��3 -�'�S- �S 7�a— �� .��ne: <br /> TYPES OF OCCUPANCY <br /> [�Residentiai ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 o��C� • � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ �O5• � <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />