Laserfiche WebLink
�O� City of Orono FOR C�TY USE ONLY <br /> P.O.Box 66 ���� �� �� <br /> � 2750 Kelley Parkway Date Reoeived: I S Permit# <br /> Crystal Bay,MN 55323 ( Ov <br /> l (952)249-4600 `-/ Amot�nt: $ �� <br /> � � l�Y <br /> , <br /> �j�kE S HO��G� ��iD �/�. . <br /> t <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 /> J�b Si��l{7��r Informa�i�n: ....`; t.,. <br /> � <br /> Site Address: �'] �l ��� �-�. l�`' ► � �-� `� �r iz- � �-- � <br /> Owner: ���^�C� �vv�.�� Mailing Address: ��� � � ��, � � - <br /> City: `� Zip: <br /> ��-�,.�-�-��� <br /> Home Phone: Alternate Phone: (P��z " � � �``' ��4 <br /> C���ii����I��c���1�nforr�ation: <br /> C ✓�Contractor/App.: S ��� 5 Contact Person:� <br /> -� <br /> Address: �( \�j' � �� ��G�,S-� . �C- State License #: �-- �' �� <br /> City: �� �- �'��i�Zip: ���'' � Expiration Date: l� i i 5� <br /> � <br /> Phone: _ � �� �' �� ��- Alternate Phone: �%Z � �S� 5 S�� <br /> �, .. . <br /> TYPES t3� {3��lJ��i��; <br /> esidential ❑ Commercial ❑ Other <br /> PERMlT T°�fP�-AND F�ES ; , , :� �.��.,w <br /> New or Replacement System $400.00 �G'�-� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> Total $ ��� <br /> 1 / 2 <br />