Laserfiche WebLink
�O�O City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Date Received: 1U��3 Permit# 0�3 ''�� �� <br /> 2750 Kelley Parkway � <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $�Gi� <br /> a a <br /> y`�l �'� �l�ry � �� _ <br /> qkfSHv�� <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 /> SiteAddress: i �iU +���'���� � '�'� <br /> Owner: �os� ���it� �v�n�r��.v� I�� MailingAddress i;io�.. �!�SOnI"VI��'�'1. I�h��(. <br /> �J <br /> City: ��1�IaItiV1 �c�Ll�e� Zip: � 5��� 1 <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> � � <br /> Contractor/App.: �:�C1�Lv� ��1�'���1 �� �I I��°�t( �-�, Contact Person: ���v�c��t��� ��U��kJti,li�) <br /> ����i� �ct,l►' � �' � <br /> Address: 1 �, .��• ldi State License #: �i��� <br /> City: ���'�r���1 Zip: ����� Expiration Date: � ��"� �`�" <br /> Phone: ��JZ '���� - `����%`( Alternate Phone: <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 ���. �:J <br /> Repair Existing System 100.00 s <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ ��� �%� <br /> W:\(Applications,License or Permit Applications)\Permits\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />