Laserfiche WebLink
City of Orono FOR/CITY USE ONLY , <br /> 4W-410 P.O.K el 66 Date Received: ��7// Perm #Li ��f T Do 57� <br /> 27501I Kelley Parkway <br /> Crys>aal Bay,MN 55323 00 <br /> (952)249-4600 Amount: $ 3 `•'� <br /> A s. 1 <br /> l• <br /> e G <br /> `•'CFSHoO' <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: c3C ole) T Y S le./ &4y' Roy. <br /> Owner: ao AA ._ r '"ie-f-• Mailing Address: <br /> City: o Co c"1 Io _ Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: 14+ iLP, <br /> r 3• c:it-0-5.0-A. 'r <br /> G. Contact Person: 3 ''` Qr"-g`I tb`4w"1 <br /> Address: $9 2 ! 0 au, ,4 t c.,5_E . State License #: Ai 1. <br /> City: I .e Zip: 5 S3� Expiration Date: <br /> PI <br /> Phone: 9`�S) 1 7 2,�2•o. Alternate Phone: 6ty 2—��©�' <br /> itil Residential ❑ Commercial ❑ Other <br /> � 7 a+'r Zx'«;L .. ':.%. x 31e . $:� ;,�." S7& l. ,,,t%17,.,. .. ...W.. t3. sa,d. „ ,r r 7a 75:7„. w .4 t <br /> New or Replacement System $200.00 <br /> Repair Existing Systen 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> Total $ <br /> � 1 W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 1 / 2 <br />