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• ~. City Of OrOno -,, FOR ITY USE ONLY <br /> �� P.O.Box 66 r�a <br /> �� 2750 Kelley Parkway Date Receive�� Permit# ' �`�J �� <br /> Crystal Bay, MN 55323 <br /> (952)249-4600 Amount: $L- GZ� : u <br /> yF � , �,�� ��/�i, %�_" <br /> G <br /> t�kESH��� <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 /> I ��-) <br /> Site Address i � ���� �� <br /> Owner: �J� �^'�I ��1 �� ►'►'� 5 Mailing Address: <br /> City: c�'�' G�" � �. Zip: <br /> ����� � � ��� <br /> Home Phone: i � ��.��1 Alternate Phone: <br /> � ,, 4 � � � � � �- c, � �. y <br /> Contractor/Applicant Information: <br /> r . r� � <br /> Contractor/A (1�����-� � �� � " �> Contact Person: �-�� � <br /> pp��.� , � <br /> Address: �—tr� � D �- � 5fi S'� State License #: L— � � � <br /> City: ✓���`f'"�` "� Zip: S� j�� Expiration Date: � 2 � � �� <br /> Phone: � � Z � o � ��� Alternate Phone: �� 5 �` `� � J' � �� � <br /> T1fPE� OF OCCUPANCY: <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $400.00 ��(� � � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> �� <br /> Total $ ��.� �� <br /> 1 / 2 <br />