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. �. <br /> ��� City of Orono FOR CITY USE ONLY <br /> � P.O. Box 66 <br /> �' — ', 2750 Kelle Parkwa Date Received: � Permit#��� � �� 7� <br /> �t.,�e Y Y <br /> a �t�?=,';. +. � Crystal Bay, MN 55323 �-r� <br /> W �Yi i> ¢ <br /> a���!�.���F�;�yo (952)249-4600 Amount: $ .J" <br /> ���oe <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLIC�k�'�ON <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> 3 ZS�' (�r�,l.�.r�. �.( � <br /> Job Site l Owner information: <br /> � ^ t:� ��/ �-''�c�i "'r: <br /> Site Address: `>� S � .=- �� .� --y '��` � - c- ���'� <br /> i J <br /> Owner: � `�' � '� `� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Inforrnation: <br /> i`�' � <br /> Contractor/App.: ,���� �,,.-� � =�- Contact Person: � > ',✓'���=z `� ;ys-� <br /> / � <br /> Address �� � � � 5 /�'��t f��'z State License #: '� /I� � � <br /> � ..- <br /> City: �''��`�'�� Zip: -> S���' `� Expiration Date: �j'�`''� 2� �='�� <br /> Phone: � �7 ��� C� �� Alternate Phone: ���- �'�� - cU�� <br /> TYPES OF CICCU`PANCY <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES —� <br /> New or Replacement System � �200.00 ,,�f��C.�' <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ ���i �� <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />