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¢�� City of Orono t� FOR CITY USE ONLY <br /> 0:< � P.O. Box 66 � -,f,Z_�� q a��r„� �('j <br /> �;,,,,p 2750 Kelley Parkway Date Received: � / Permit# 0 <br /> ��'�'r��f'' � Crystal Bay, MN 55323 <br /> � �Y:9".�� Amount: $ ���� <br /> �����o�..ya (952)249-4600 <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 /> Site Address: �� � Z-� ��� � � �c� �,�- <br /> Owner: �L, �z�S �,r='olv-��� �- Mailing Address: ��2� f�rc,G-� Lc,� <br /> City: ���� Zip: �S � z--� <br /> Home Phone: �i S Z ` �t 73 — `��zC� Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: ��c�L, e � `�5�. S Contact Person: l� (L-� � <br /> Address: Z �= � �Z� s�f 5 L ' State License #: � �� <br /> City: l t�.�--- ��-2,� Zip: ���v� Expiration Date: v��- - ��% <br /> Phone: � � � � `f 7�� / ?� '�-- Alternate Phone: �r�� r ��2 � G ��S"� - `�S S t� <br /> TYPES OF OCC'UPANCY <br /> �Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 �.c� U <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total � �% <br /> $ Z `= ,� <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />