Laserfiche WebLink
� � ,��� City of Orono FOR CI USE ONLY <br /> P.O.Box 66 / y �/ /� �j <br /> �s,�� � 2750 Kelley Parkway Date Receivecf`� ` va Permit# �U 'O� � <br /> 6��� �+�. � Crystal Bay,MN 55323 /,-g-�? j� <br /> � ���o` (952)249-4600 Amount: $ f(/C/-'��✓ <br /> a�o <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 l Owner Information: �" ��':'�"�'��, <br /> -� _ _� <br /> Site Address: ,.�.%� �-��/� J� 1�� ,�� � <br /> � <br /> Owner: �J /Z�l� � �i � cl.e��S Mailing Address: Cvv(�,� E��z rc�} ►�c�. <br /> City: �l-.�:� t,,��; d Zip: 'S S ��3 l <br /> Home Phone: �� �� ���c:> - �� � ? Alternate Phone: <br /> Contractor/x Ap.plicant I�nformation: 'r � �`�`�� <br /> Contractor/App.: I<<'-1� '►��� S Contact Person: <br /> Address: �P��� K� � G;k � C1 State License #: � �v� � �J <br /> City: f�e r Zip: ��� �� Expiration Date: � o� ��1 <br /> Phone: T�a - ��3 �� O(o Alternate Phone: <br /> �.,°� i �'��e„t ��µx.t�� °",�„� '�y ��'�'3 �'`�,¢ "i�f tki4� i: � �N � �, �v �°. �? �. <br /> ��� �._ � .� �.���,,���� ��k.� . ��, TYPES' OF OCCUPANCl' ���, ��`�'�_ ', �r,�. �,��..�.` �,� _�„� <br /> �� �. <br /> Residential ❑ Commercial ❑ Other <br /> �; ���y;�_������� ry �,���, �.x ��;, .�.�� ,�:�.�.,�``PERIVI`IT �'YPE AN��FEE',S ,��,�,�^���s � ,. , <br /> New or Replacement System $100.00 /C�(� Gv <br /> Repair Existing System 50.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ ��C� - � Q <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />