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s • . Cl�`�`"' <br /> 0 City of Orono � / Ff)R CITY U5E ONLY <br /> ¢ � P.O.Box 66 <br /> , �. � '� �� <br /> 2750 Kelley Parkway l Date`Received: �Q Permit-# a�—d /� <br /> Crystal Bay,MN 55323 ` <br /> ���,� �s52�zas-asoo �mount: $a?���J`.O <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 /> Site Address: I �-{ � �l C� hv,� �� Vc� l,� <br /> Owner: �-��� �`�`'s`���-'� Mailing Address: 5 a�� <br /> City: C� v-��'�� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: �u c��s �.5�n/ S Contact Person: I� �� <br /> Address: 2G`3 82'='� �.} S � State License #: �e �C� <br /> City: j/1it��-nr�e Zip: �"3 b 3 Expiration Date: � z� 3� -o� <br /> Phone: 7F����s- i 7( `Z Alternate Phone: ��2- ��3"-t'S'�o �e r <br /> Residential ❑ Commercial ❑ Other <br /> New or Replacement System $200.00 �� C� � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) . <br /> State Surcharge .50 .50 <br /> s z' <br /> Tota I $ Z-�� �--�" <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 /2 <br />