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ji,o� City of Orono FO CI USE ONLY <br /> ' O. Box 66 �" (� O� Permit# aOO cj-CC �- <br /> { W 2750 Kelley Parkway Date Received. JJllf, <br /> � Crystal Bay, MN 55323 Amount: $ 0700.56 <br /> (952)249-4600 <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 r c k r 4{ C -c-C) <br /> Owner: D.",_5 W r 3 Mailing Address: 54a- <br /> City: rcryN0 Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: 1-4CA I e5 Contact Person: (fib <br /> Address: ZG 3 S4- S State License #: CQ 4 O <br /> City: /r° —e Zip: 5S3 4,3 Expiration Date: <br /> Phone: 767 - /76 2, Alternate Phone: (.9/1- 1556 <br /> `:. fir <br /> _ ..,,'�`> .�>�.��"e'N, -,:�""Cr.��s�s a`k-," <br /> Residential ❑ Commercial ❑ Other <br /> I v,1,.::!„7711.177-i3).',77 <br /> m �'e� ,_" "TM�`�'l <br /> h s 3 ! , 3 ¢a ', £,° <br /> New or Replacement System $200.00 <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge .50 .50 <br /> Total $ Z 00 5' <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 1 / 2 <br />