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,� . . <br /> 40� City of Orono F R C TY USE ONLY <br /> P.O. Box 66 <br /> �" �1 2750 Kelley Parkway Date Received. �D Permit#p���' <br /> �.:�,.�� <br /> �'� �'�"%�'' �� Crystal Bay, MN 55323 <br /> ����u��;� � <br /> �^r'HAF' �t��p o (952)249-4600 Amount: $��(,�f.,� <br /> \y ` �IA �' <br /> \!�Eex�4 <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: %�G i � , /�/l�lL /, ��i2�-�N�ti! %�iL � �GI4 � <br /> Owner: f_�VLiC E ����lLlv�,�C �� ���5 Mailing Address: �jZJ �.Sl-�i��tlt� �l�L,j�. <br /> �j��J�i7iCS `-- <br /> City: ��-1 i/ - G-1-n-�-- Zip: S S�j � <br /> Home Phone: ��S z) �/�(1 — ��i s�' �.,, Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: �, ti�, L"f������i��-Tr«�� �iC� Contact Person: �T��E �l,C�'ti� <br /> Address: 3�I�U CL►�il/c.irlr 12Gi��( ( State License #: f ���� <br /> City: iZ Zip: SS3�°� Expiration Date: <br /> Phone: CiS Z� G/<S S -�//Z Alternate Phone: ��/Z 1(��S� �1���� <br /> �C��2� L�f�S" � ��3G�- <br /> TYPES OF OCCUPANCY <br /> [�] Residential ❑ Commerciai ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 �cb � � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � Z�,j ��' - <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />