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..4--...--,i, City of Orono FOR CITY USE ONLY <br /> /Q PO. Box 66 orl0/D AVO SL <br /> a�£:. 2750 Kelley Parkway Date Received:41/57/0 Permit# <br /> °fitCrystal Bay,MN 55323 <br /> NliV <br /> (952)249-4600 Amount: $ <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 /> ner Information: <br /> Site Address: Lo ( 5 () v cil 4-,d , t'A v ie c� Q <br /> Owner: K.C.v r h Lc.,1,-cc Mailing Address: Co I5- OP rI P, V a' <br /> City: 0 Vt Zip: <br /> Home Phone: Alternate Phone: <br /> ,a - rk,� �.�t �F{,:.tea rT' i• 41� lij `� . <br /> 2 1,F .',. k". .4,, ...1r gin. ti <br /> Contractor/App.: {4,gy-es 1 5oi'l 5 Contact Person: -62-'4Q <br /> Address: 2-6-3 T2- 251- 565- State License #: (0c D <br /> , 10/c 61- <br /> City: 4h �rfroLe Zip: 9--;3‘, 3 Expiration Date: z'jZ- <br /> Phone: 7‘, 3- L('7 e / 76 Z- Alternate Phone: cp(z Sr5 -r 5T0 <br /> is..- .,-' U.F.... ....�..«��... :s., -,,,L-1-:::- <br /> ,,L,�.. <br /> .u .a .. . .. ... <br /> �w.7fi� I , : „.-;e,,�::.:� :sxsa..,.uuwta.... <br /> Residential ❑ Commercial n Other <br /> § mar^-� ..-, '; m �,. ':17F-: <br /> Z ``, � �ea .�:. <br /> 27 1.1.::', . 31,;a ,.9..:, .:17-1P1777-77. t, - � . ,.w.,v�a .L„. 4 , u ;_ <br /> New or Replacement System $200.00 Z c... <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total 2 c? c) S-1; <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />