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1 <br /> City of Orono F R USE ONLY <br /> ���� 2750 Kelley Parkway Date Received�+� Psrtnit����� �� <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Amo�nt: $'� <br /> � � <br /> s� � <br /> !,'�FS H 0��, <br /> � <br /> CITY OF ORONO-SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> ¢z����,��'�� : ;� <br /> �.f:, <br /> Site Address: 3�� /`/a ��an A�r Q�� ��e.- <br /> Owner: �d r1� �nn�r' Mailing Address: <br /> City: ��D h d Zip: <br /> Home Phone: Alternate Phone: 6/� - �f'� � O�lf� <br /> ! � ���r�����t <br /> ,�F=� ,,;�� ��, �. ,.r,r s*'�p' <br /> Contractor/App.: f�a 'tno � ,R���i��1 ��. Contact Person: ��u�•+ C�a���-J <br /> Address: �?5��/ �a,���r � �c . State License#: L 3�y3 <br /> City: Sf-�i c .� Zip: .SS 3 7G Expiration Date: �- / 7- � O/� <br /> Phone: 6 i 3 -9/9-a�r� Alternate Phone: 7 C 3- Y�'-3 y!G' <br /> ,..: :; � .r'T,7 '�fi 4i P'�4� �, :.� ... � � � �� .. �, �� <br /> 4�'� a a':. , �, .s g< �... �.ab � .P xy t x�$"✓h b �'�1,e �a��,2`t Sv- <br /> ^ . ' .�. :. -�'" ' ��` , , ��p �� � •t. <:, „to�.�-�� .�,,,y'M" rs. �s x`f'� �.,��, <br /> . . • n � ,�,. ,�,� WK .z y ` m�� �> <br /> �s: <br /> ❑ Residential ❑ Commercial ❑ Other <br /> i" �� �`�' �,��`���"�����'�� S�`�" z,4�`,�:�w( '�,� �d�`"'+'�«�" t �� �.� 1��t �F� 'fF <br /> '�'�.�.�. 5.t�,.iy t ��rY��i�d. '",.ya��.�'S"�d t.��. ,� �!. . � r "r�c' :a. ,�' tl..aa wt3 �4" �r "�'`'�'t xx <br /> New or Replacement System $400.00 -,' yoo.od <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Tota1 $ yo s. o0 <br /> 1 / 2 <br />