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� <br /> t <br /> ,/'����"�,� City of Orono FOR CITY USE ONLY <br /> / �.���� P.O. Box 66 / � Zcl�-�' 7� � <br /> % 2750 Keliey Parkway Date Received: lt� I( �JS Permit# <br /> I � Crystal Bay, MN 55323 <br /> f (952)249-4600 Amount: $ <br /> ..� y, <br /> r � <br /> (� j✓ <br /> ��'�E'S}i t7�� <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 /> Job Site / Owner Information: <br /> Site Address: � �(� �Z�.�`-�-ti�� �v.-e <br /> Owner: c,,., � rr.eS Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: ���¢����� s`'(' ' <br /> Contractor/Applicant Information: <br /> Contractor/App.: � -�S �S u-z. 5 Contact Person: y� <br /> Address: � S� �ZL'��t.S� State License #: �� �v <br /> � N E '� <br /> City: ���.P Zip: ���� Expiration Date: ��,Sr <br /> Phone: �j�Z • � 7�_] U CZ �, _ Alternate Phone: �� ����� 76 z-- <br /> �v s i��,,� <br /> TYPES OF OCCUPANCY <br /> Residential ❑ Commercial ❑ Other <br /> PERMiT Tl(PE AND FEES <br /> New or Replacement System $400.00 �J <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> c,c1 <br /> Tota I $ � �'�— <br /> 1 / 2 <br />