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f .•r <br /> City of Orono ��/� FOR CITY USE ONLY <br /> �4��0 P.O. Box 66 Date Received: �•- f 1�S Permit# �. '�= C � � -L- <br /> � 2750 Kelley Parkway 7 �s �` t -- <br /> � �� t�� Crystal Bay,MN 55323 � .. �, � <br /> ���'���o� (952)249-4600 Amount: $ <br /> (.j L�i.- . ',�i�// ? <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 /> ���� ���� <br /> Job S�fe=��.wr�er��r�#n�s ,� ��� � ,��, ��� � ';�;. <br /> ,.�.. .. .�- ., . . . <br /> Site Address: � � L--� �� �� � <br /> Owner: ��`��-`� �''� `�` � `��"l Mailing Address <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> ��,��� <br /> �ontrac#or�k.:A��licant lnformation �_ { � <br /> �, � ,m�� � <br /> C. -�S �� �`�,'4 �/ <br /> C�ntract�r/AN�.. vI 5 C�ntact rers�n. <br /> �-�r <br /> Address: G � � � "� 5�` S� � State License #: � � � � <br /> City: �''�'"�'""s� Zip: �S� �3 Expiration Date: Iv o v_ Z o l -� <br /> Phone: � �` 3 � � � � ' �?�Z Aiternate Phone: � � Z� � �l �SZ <br /> E n;' � �� Y ���T`YF;E��i�3�..�J��C�G ���At� �� "�+�' ,'`."� � ���.. ",~ � , : <br /> �,� E � .� <br /> . .� : <br /> : . , a <br /> a.. . � � <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES �, <br /> `�- --_-- <br /> New or Replacement System $200.00 2� � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ Z � � `+ <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />