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r ,��� City of Orono ' `� <br /> �15E�WL� <br /> • � � 0 P.O.Box66 ;�� � .w.�� �� O�� <br /> 2750 Kelley Parkway °dafe F�e.cewed ��� �� � Perrr�it���*�� ��� <br /> a� � Crystal Bay, MN 55323 <br /> � (952)249-4600 �p�fl� ?` �� ���� <br /> ��� <br /> CITY OF ORONO— SEPTIC SYSTEM PERMIT APPLICATION <br /> (Alt permits must be approved by the On-Site Septic Manager andlor Building Officiai) <br /> Site Address: c,( � y v ��r�� ��1.dv� �,�r U� <br /> Owner: ��� I"t�ld�lr' Mailing Address: <br /> City: ��Ir�n n C� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: /��I c,,.c5f ��'��r-��8� �G� • Contact Person: � /VIu��C�a�v <br /> Add ress: �,S��� .�..C,L')�� ��T State License #: ��� �-�- <br /> City: �.��e PGt.�►� Zip: S� C3 C f Expiration Date: �� ��!3 <br /> Phone: �� �����.��- ` � Alternate Phone: f S�— 9�y /j! 7 <br /> �Residential ❑ Commercial ❑ Other <br /> New or ment System $200.00 <br /> Repair Existing Syste 100.00 !�G � �� <br /> (Tanks or Drainfiel <br /> �__ <br /> State Surcharge 5.00 5.00 <br /> Total $ <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />