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¢�� City of Orono FOR CITY USE ONLY <br /> P.O. Box 66 �c�nQ p q <br /> ��;,,,� � 2750 Kelley Parkway � Date Received: � Permit# w �Q � � <br /> .� '� h". � Crystal Bay, MN 55323 V� <br /> ��'�.Y�aZ � � ��`� Amount: $ .�� <br /> ,,�,�p$G` (952)249-4600 <br /> ��meao$ <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: � �i � � f�} � C� � �� '�-`�-- <br /> Owner. C��'� � �"� �� ���� Mailing Address: 3 `��S /�,�,�� ����.� <br /> City: � ��f� Zip: <br /> Home Phone: �i 5 Z - �-f ��6 - (o O � � Alternate Phone: <br /> Contractor/Applicant information: <br /> Contractor/App.: � c,��,�5 � 5�, ,,�5 Contact Person�R�� <br /> w� <br /> Address Z� � � � S fi � �' � State License #: �..� `-E � <br /> City: /'�7����� Zip: 5 5�� Expiration Date: r�� b`1 <br /> c��l <br /> Phone: � � � -`r7� "%l��- Alternate Phone: C�t Z � (�; � -`7SZ,'Z, <br /> TYPES OF OCCUPANCY <br /> �esidential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Re lacement S stem $200.00 �Z-`�� <br /> p Y <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Tota I $ �=� C� s���' <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />