Laserfiche WebLink
, a � � <br /> '� ; City of Orono �I'j,�I �\ FOR CITY USE ONLY <br /> ��' �a��. P 00 Kelley Parkway Date Received: � �7 � Permit# 4�0����d� � <br /> � 3���� �; Crystal Bay, MN 55323 <br /> t a, .�aa;< (952)249-4600 Amount: $ aoy�� <br /> ��.:.:'Qk�.pB.;:! <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 /> s�te AddreSS: 3215 Graham Hill Road <br /> Owner: K21th KOI"SI Mailing Address: 769 Boulder Drive <br /> c�ty: Long Lake Z;p: 55356 <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/A Burns Excavating, �nC Contact Person: SteVe BUrt1S <br /> pp.: <br /> Address: 3470 COunty Road 21 state �icense #: � 888 <br /> c�ty: Mayer Z;p: 55360 EXpiration �ate: 3/2012 <br /> Phone: �952� 955-3� � 2 Alternate Phone: (612) 685-4303 <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 200.�� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Tota� �205.00 <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />