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� � � <br /> O City of Orono FOR C TY USE ONLY <br /> � � P.O. Box 66 7/-1 C <br /> 0 2750 Kelley Parkway Date Received:f0�� � Permit# �S- 90 ! <br /> Crystal Bay,MN 55323 a(� <br /> (952)249-4600 Amount: $ °'- � <br /> � � <br /> � ` <br /> F! �' g�S;�i'`� Y;��-`� `'W� '� <br /> �kESH�R� «��_ i <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (All permits must be approved by the On-Site Septic Manager and/or Building O�cial) <br /> Job Site / Owner Information: <br /> Site Address: ���,7��� � � ��i� <br /> Owner: Mailing Address: <br /> City: ( .� ./���� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant lnformation: <br /> �' �-. <br /> Contractor/App.: �,�, � �!,�,,��� Contact Person: �-z-���.'".,�--� _ <br /> Address: ��' `���� ,�4—/� �G State License #: �. �� �� <br /> �� <br /> City: � ,� Zip: �� �� Expiration Date: <br /> Phone: ��i � / �� ,��� Alternate Phone:� � L� �f � ����0 L�/ <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> - � <br /> New or Replacement System $400.00 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> /�,, /�y � <br /> Total $ 7 '�(y <br /> 1 / 2 <br />