Laserfiche WebLink
� City of Orono FOR CITY USE ONLY <br /> • �¢ �� P.O. Box 66 (�IzJ���G� � 1 �� <br /> � 2750 Kelley Parkway Date Received: Permit# <br /> la �'��X�,;;�'. � Crystal Bay, MN 55323 cjC� <br /> � � ���,y��,�oyo' ( (952)249-4600 Amount: $�_ <br /> �!r�Ko <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� � �`, ,� L �� lV` � �- /�� � <br /> Owner: �/�-rov� ��-� � -� v� Mailing Address: S�'�-� �� <br /> City: �r � ., � Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant information: <br /> Contractor/App.: ��c���;, ��r �:� ,. � ��%�-"�'�- Contact Person: �- Y �� <br /> Address: �7 i� 6 ������ Y � � �� State License #: ��`� <br /> � <br /> City: ( e C- Zip: ��� d� � Expiration Date: � �° �3 �o <br /> Phone: �.� 3 �l � � — �"� I z- Alternate Phone: 6 � 2� 2 S� � ��� `r� <br /> TYPES 0F OCCUPANCY " ` ` <br /> ��esidential ❑ Commercial ❑ Other <br /> ,.,�;; PERMIT TYPE AND FEES <br /> �, � �. <br /> New , r Replacement System $200.00 �a(:� � U� <br /> �. <br /> � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ v� � c� , �� <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />