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�¢�� City of Orono ` FOR CITY USE ONLY <br /> '�"_� � 27050 Kelley Parkway Date Received: "7i (� Permit# T�'1� � t- � J� <br /> � ? Crystal Bay,MN 55323 �1;,' <br /> �9+'��� � Amount: $ ��.�` <br /> ��i o�$a (952)249-4600 <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 /> v . <br /> � � � � (- ��SC � <br /> �4{ ��I`�i�ine�I�i#o� ,�r p �C-�.� <br /> � �,_. v � r�a�c�ra: ,,n s�� ./ <br /> Site Address: � / (7n /�/l�/� � f c� � 1�v.� ca � <br /> Owner: � G1/1/ �PS (3��(1rP ( f Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> GQntractor/Applicant liiforrnation: �R��`v' <br /> Contractor/App.:�+ C�J A^�e ci �=���v� Contact Person: �� I�Q <br /> Address: �U� �A � 1� l�u•',c� S� C,_S State License #: ��'s ��/ <br /> ��cti� �A ( <br /> City: N���`�`='� `��'^�Zip: S��� Expiration Date: � "�D�.3 <br /> Phone: �'� (v1- 3�� ^ ��'� � Alternate Phone: <br /> �;} � � ,���� T��ES�F'�CCUPANC;.� ����,�� �,_ � , � .7,,���;w � „�u . r��� .�„� ���� .. <br /> ���� .?l � � kd• ��d. .��a �P "' �.. <br /> � Residential ❑ Commercial ❑ Other <br /> �— PERMIT TYPE AND FEES <br /> , �, <br /> New or Replacement System $200.00 ��.-- (.. . C C <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ �U��� <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />