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Ciry of Orono FOR CITY USE ONLY <br /> 4-�� P.O.Box 66 Date Received: �Z �� Permit# �D�✓�D /� <br /> 0 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ �YtS '(/�" '�B� <br /> � � <br /> ti � <br /> F G <br /> �1 kE S H OQ`�c. <br /> CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION <br /> (Ail permits must be approved by the On-Site Septic Manager and/or Building Official) <br /> Job Site / Owner Information: <br /> Site Address: `� 1 1 �E�ti.�G1�lLli �Ot�k:l Jllb(�77-� <br /> Owner: �7���r.,�� i'�n���r2��t1 _ Mailing Address: //o£sZS �tir�[,t4�u�; �'•�- <br /> City: �'l�ti.l ��G�',i1�Z�� Zip: .s�S3�7 <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: ` <br /> Contractor/App.:�3�,<.�� �ce:�(h;�Ar�,,� Contact Person: ��i.�� <br /> Address: ��b �l.f�tt�l ���'� Zl State License #: / �� <br /> City: 1�- Zip: ,�5�(�1� Expiration Date: 3 I Z�IZ.C�Ilp <br /> Phone: �y�� g.� '::31I Z.. Alternate Phone: f(�pf2� (p� -�.3�i� <br /> TYPES OF OCCUPANCY <br /> [�, Residential [] Commercia) ❑ Other <br /> I _ <br /> pERMIT PE AND FEE$ <br /> New or Replacement System $400.00 ��UD � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfiefd) <br /> Total $ � L�U� � <br /> 1 / 2 <br />