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�,�p�� City of Orono �oR.CIt`��tsE o�It.Y <br /> P.O.Box 66 � D�� <br /> 2750 Kelley Parkway k D�#e�f�t�Ved�+���� Perrn1#� +��'"� , <br /> � �� � Crystal Bay,MN 55323 � '� �� � '� �� <br /> ��� (952)249-4600 +�tTiOr�rif ° � � '� <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 /> Site Address: � �S /-} •r�'� �"�4 ��^ �� • <br /> � <br /> Owner: (�� �SSa�� Mailing Address: 5 �-""� <br /> City: _� V��� Zip; <br /> Home Phone: Alternate Phone: � �Z'^ �� � Z `�� � <br /> Contractor/App.: ��-y-23 ���'hs Contact Person: �2�-� <br /> Address: �� �� �'� - State License #: � � � <br /> City: �?��� Zip: 5'�3� 3 Expiration Date: `�- � �3 <br /> Phone: � � � � �{ ?�- ( ?� `Z Altern ta elPhone: ��2 �� $5- � S�� <br /> Residential ❑ Commercial ❑ Other <br /> New or Replacement System $200.00 _ `�_c� c� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> � <br /> Total $ Z p � <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2 <br />