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C} \ <br /> City of Orono FOR CITY USE ONLY <br /> � f'4�' � �, P_o.soX ss q o�-�sv-�f-a 5�� <br /> �., �`?� 2750 Kelley Parkway Date Received: I�� Permit# <br /> ;` � �. h Crystai Bay, MN 55323 (� <br /> � ��►��; � C� Amount: $�_�`� <br /> � � �f���o/' (952)249-4600 <br /> ,i�a,�co�;%, <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (Atl permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Job Site / Owner Information: <br /> Slt@ Addl"eSS: 3415 High Lane <br /> OWner: Richard & Nina Marklund Mailing Address: 3415 High Lane <br /> Clty: Long Lake Z�p: 55356 <br /> Home Phone: �952)475-3362 Alternate Phone: <br /> Gontractor/Applicant Informatian. <br /> ContraCtor/App.: Burns Excavating, Inc. ContaCt Person: Steve Burns <br /> Addr2SS: 3470 County Road 21 State License #: �$$$ <br /> City: Mayer Z�p: MN Expiration Date: 03/21/10 <br /> Ph011e: �952)955-3112 Alternate Phone: (612)685-4303 <br /> TYPES'OF OC'CUPANCY <br /> ❑✓ Residential ❑ Commercial ❑ Other <br /> ' PERMIT TYPE AND.FEES <br /> New or Replacement System $200.00 $200.00 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � 200.50 <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />