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\ City of Orono FOR CITY USE ONLY <br /> 1V\ P.O. Box 66 c� <br /> 6 2750 Kelley Parkway Date`Received: Permit# c7elo9." (D <br /> Crystal Bay, MN 55323 <br /> �Koeo c (952)249-4600 Amount: $ ©"=51) <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: ?O Q (I C-7 S , / /?& 7 <br /> Nem 30S-1 .- <br /> Owner: e- Mailing Address: (-4 nilew 1-t' <br /> City: Cl) Zip: <br /> Home Phone: Alternate Phone: <br /> Contraator :Applicanthiformation. <br /> Contractor/App.: act y es cl-50^-) g Contact Person: 0 <br /> Address: -2-Q03 <br /> Z - S L- State License #: 4 <br /> : " e Zi S 3 v3 <br /> Dec, <br /> City: p: Expiration Date: 0 9 <br /> Phone: 3�- ?(O3 - L-C) 9 ( '? � 2. ce I ( <br /> P Alternate Phone: Co ( 2 - C9 - 9 S--(5-CM <br /> TYPES OF OCCUPANCY <br /> <Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $200.00 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> s� <br /> Total $ Z c� ) <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 /2 <br />