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4 � . <br /> �' — <br /> g�� City of Orono FOR CITY USE ONLY <br /> O � P.O.Box 66 c d l - p r. <br /> , 2750 Kelley Parkway Date Received: _����1� Permit# __��_______ r�(� <br /> -+ "�� � Crystal Bay, MN 55323 1� /� <br /> � 'Y o` (952)249-4600 Amount: $�v�'�`� <br /> �'xraHa�'�' �I <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 /> -� al i � <br /> Job Site / Owner Information: � <br /> Site Address: j'S I � ��IC�II-I��i(��� �-�C j� �vl��-� <br /> Owner: ���^��� �-��I.LI�LI 1L�C� Mailing Address: �L� G��� � 7k��L-i `iL <br /> /�" z 1�`� <br /> City: /�-�l/�/l//U�J��1l��c��� Zip: 5.���/C:�� ��� <br /> Home Phone: Alternate Phone: � <br /> Contractor/Applicant Information: <br /> Contractor/App.: 1��(,L������ f`x(' �-11/j�377J�f ,Z�C'�Contact Person: �T�11te �(�L/Zll,l�. <br /> Address: ���7U ���L i/t��V /�Gl�k'_� L� State License #: J �`c�� <br /> City: � r" "i� Zip: _`�5�!l � Expiration Date: ���d�� <br /> Phone: ��5 Z� C%5� - -3%l Z Alternate Phone: �Cv/2J �i�S �`-/,.�C��. <br /> TYPES OF OCCUPANCY � <br /> � Residential ❑ Commercial ❑ Other_______________________ <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 r�(.,`�,' �' �" <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ �-� l�cJ � v <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />