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,�0� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 <br /> a�, �, � 2750 Kelley Parkway Date Received:�� Permit# 9�d� Z____, <br /> � 1j�,�`�. � Crystal Bay,MN 55323 <br /> ����o$�o` (952)249-4600 Amount: $ <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 / Owner Information: , �� ��'� <br /> Site Address: J � � /`�l c�LL�-.�iJ�/� ���:D <br /> Owner: ���t+e �� ;,,v.4-�` Mailing Address: 5�--�.:�' <br /> City: , a�E'v tiv Zip: S�S�,S� <br /> Home Phone: `� S� -� �`7 S — l�S ��Z Alternate Phone: <br /> Contractor/Applicant Information <br /> �.; _ . , <br /> Contractor/A / f �� <br /> Pp�� �tiO��� d' �a y '� Contact Person: f�� <br /> Address: �3ac�o l o� �� /-�cJ� State License #: `�s <br /> City: o��5 Zip: 55:��7`f Expiration Date: 7 / ��/," <br /> Phone: ��Co3 - �{�.� - 73�,3 Alternate Phone: 6%a - �I�o� - ��� v <br /> � TYP:ES OF OCCUPAN"CY �., <br /> # � �s � <br /> � �,� ';� �..� �. .���.�� t;,, ��� �:: <br /> .`._ <br /> Residential � - ❑ Commercial ❑ Other <br /> . �� , <br /> �� q ;� � � �.' : � '� � � � PER�MIT ��I�PE AN�D F��EES <br /> , <br /> � `�- <br /> New or Replacement System $1 � "o ��'(7 <br /> � <br /> Repair Existing System 0 <br /> (Tanks or Drainfield) <br /> State Surcharge . .50 <br /> Total � � � � 5� <br /> �� <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 1 / 2 <br />