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f � 1 ' / <br /> . � � �� J� <br /> City of Orono FOR CITY USE ONLY <br /> i'g'�� '� / / ��7 <br /> O O", P.o.BoX ss ��L�la /b-D °2� <br /> f ,;, 2750 Kelley Parkway Date Received:� Permit#� <br /> ���� j`��'�. t�,� Crystal Bay,MN 55323 <br /> ���•,J,�`:� (952)249-4600 Amount: $ <br /> �_��i / <br /> N � /�/I <br /> � // /�-- <br /> ��'�/� r�S <br /> CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION ��vL <br /> (All permits must be approved by the On-Site Septic Manager and/or Building Official) � / <br /> Job Site/Owner Information: <br /> �=' `� � <br /> Site Address: �� � ' � ��lrY� c: � � � <br /> Owner: �Y� c%,i�1 /�r' I J /�''� F �Z Mailing Address: <br /> City: (�� ��l� 7� U Zip: ��3c1 � <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: 1�l'����� �� ,�1�'c�f� ��i Contact Person: - ` f��� +� <br /> Address �-�����C.�� L�1 � 1� r c,o /� �.�P ��'�State License #: �� -� <br /> City: �/`JNt��j�`--��' Zip: 5 S 3�� Expiration Date: � 1 � � '`�" � � <br /> Phone: �_� ��� ` �� �l �'; � � �5 y Alternate Phone: <br /> /� TYPES OF OCCUPANCY <br /> 'd Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 ,T C�i (:U �:c.v <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ ��`-' � ` "�' <br /> �. V1(;\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 1 / 2`� <br /> �,�o <br />