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,Jul 1?�2015 02:37PM HP FaxKlingbergs 9524473982 page 1 <br /> �O� Clty Of OrOno �— FOR cITY USE ONLY <br /> /� P.O.Box 66 / <br /> V 2750 Kelley Parkway Dale Received: �fi}—'-�-' Perm,i# _���Y�—E.� <br /> Crystal Bay,MN 55323 �`/ <br /> � (952)249-4600 Amount: $ <br /> � a <br /> y� V <br /> 1�K�'SH��� <br /> CITY OF �RONO -SEPTIC SYSTEM PERMIT APPLICATION <br /> (AII permits must be approved by the On-Site Septic Manager and'or Building Officiaq <br /> Job �i#e�/C�r lnfarmatfan� �.� <br /> � <br /> Site Address: �3 7� ��Z�}f.(�}l/yl 1�( �,� �a, D�U/�/C� /Ul�'�/ <br /> Owner: �J{�-) r� � (�,';�'�"' C�a�� ���� •-�--� ; _ <br /> � t� 7 ailing Address: lb1�,�°tio �`��'t�,K� <br /> City: Cc � . �l�k '�.z.e�C.�. (�2 #/01 Zip: 5 S'��/� <br /> Home Phone: q•���3�S�-���f,� Alternate Phone: ���.�'� ��� -3(c3 - <br /> 3 S� <br /> Contrack+�r d Applicant �nformatian;�� <br /> Contractor/App,: �IYI �f xG41,;4��V(' �y��Contact Person: �-.E �.. c�� cl�+�' <br /> � <br /> Address: �� �� 5tate License #; `7�9 <br /> City: Y��D� ��ip: �jr3 � Expiration Date: c� � �C�f� <br /> Phpt1�: �� ��� - ���� Alternate Phone� ��a"a-Qg-q�� <br /> A1a M�Ss4���. <br /> T'YPES OF bCGUPANCY _�� <br /> �Residential ❑ Commercial ❑ Other <br /> ; PERMIT TYPEAND FE�S <br /> New or Replacement System �400.00 �-�-�D '' <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> Total S `�f D4 �� 'V 1'�- U S.�'1� 1 <br /> 1 / 2 <br />