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�� r <br /> , REC�IYED ��3� J <br /> � City of OrOno �O/R CIT USE ONLY <br /> ����0;,\ P.O.Box66 5�P 23 �Ott DateReceived. f / Permit# ����� ��0 ( <br /> � 2750 Kelley Parkway <br /> 6 j}� �.,' Crystal Bay,MN 55323 Amount: $ <br /> a+t �.:; .,�o�. (952)249-4600 �„/,k�Q�"��,�1� <br /> ,':'!ernxa4`,,' <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 /> s�te AddreSs: 2350 Longview Circle <br /> Tom & Suzanne R an 2350 Longview Circle <br /> Owner: y Mailing Address: <br /> c�ty: Long Lake Z;p: 55356 <br /> Home Phone: Alternate Phone: (612) 750-7926 <br /> Contractor/Applicant Information: <br /> Contractor/A Burns Excavating, Inc. Contact Person: SteV2 BUI"nS <br /> pP.: <br /> Address: 3470 County ROad 21 state �icense #: � 888 <br /> c�ty: Mayer Z;p: 55360 Expiration Date: 3�20� 2 <br /> Phone: �952� 955-31 12 Alternate Phone: (612) 685-4303 <br /> TYPES OF OCCUPANCY <br /> ❑� Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 200.�� <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Tota� �205.00 <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 /2 <br />