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•� - <br /> City of Orono FOR CITY USE ONLY <br /> •���� P.O.Box 66 ! <br /> � 2750 Kelley Parkway Date Received: 1 /����^ Permit# 1���� � �� <br /> � Crystal Bay,MN 55323 , Q� ,�' <br /> (952)249-4600 Amount: $ <br /> � � <br /> �' G� <br /> t�'�ES H�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 /> _ � ��'����� I� <br /> �b S�#e/t}�er lnfv '::���� � �-��°���: r ,� <br /> ;..., .. ,�n� w :. <br /> Site Address: �1 S �-�cn L.�At-t;n � �Z, �o��, <br /> Owner:'c'�o� 4� �f-- �-�v CZPt ��.f�f'� Mailing Address: ���� ,�-S � �T� <br /> City: O�r1r� Zip: -,�S 3�i i <br /> Home Phone: �'-�,.�2- 33�4 � .35 '03 Alternate Phone: �12- gro�'�4yy <br /> \ �(�,-\ l \ � �'P�--� `�/"��\ \ ��--�-��-�--= `r^ .� �t��rr-,�_�i D� <br /> �ntr�i�csr�,���p����i�nrlafiic�n: <br /> 1 hl ST�`.� �'� <br /> .,,�. Z. C.. <br /> Contractor/App.:��(Es .� �dKs �Y��-A�AT�' �o�itac�erson: �R�D �A�t�5 <br /> w�p C At- <br /> Address: P•b• go,1• t`� � State License #: L ���j <br /> Yh M <br /> City: ln�AeL� $L-I��t�c , Zip: .s S 3 S� Expiration Date: _ �,cS \$ <br /> Phone: ��3 �- `t� � 119 2 Alternate Phone: �12 - �c�S��SS a <br /> � p <br /> '�1(PE'� 4F��C���►��`:� ��* � � � � <br /> ������. ��� <br /> '� Residential ❑ Commercial ❑ Other <br /> �� � � � � �� .;;._ : -- � � PERM�T TYP� AN�D�FEE� � � <br /> New or Replacement System $400.00 � �dc� ,� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> Total $ �c�� � <br /> 1 /2 <br />