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� <br /> ' � +� <br /> ��-+��� City of Orono FOR CITY USE ONLY <br /> � P.O. Box 66 � <br /> 2750 Kelley Parkway Date Received: s � �S Permit# ���"� <br /> Crystal Bay, MN 55323 <br /> (952)249-4600 Amount: $ <br /> y� � <br /> CL <br /> ��kESNt"l�� <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 /> Job Site / Owner Inform�tion: <br /> Site Address:_�� ('�f; �i��-� �.l'� z�� � 1�- <br /> Owner: �oYc.Qo� ��v�S Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Gontractor/Applicant Information: <br /> Contractor/A .: / "4 �s �5�"`�5 �"� <br /> pp � '� Contact Person: � <br /> Address: �-� � �Z �S� $'� State License #: �— � 't� <br /> City: �°�'�`'�`t� Zip: �S� � � Expiration Date: / Z /S <br /> c.� �� <br /> Phone: �(� � '' y7 �t � �76 Z-- �e�rta�e Phone: ��2- � �fS y� <br /> TYPES OF OCCUPANCY <br /> Residential ❑ Commercial ❑ Other <br /> PERMIT TYPE AND FEES <br /> New or Replacement System $400.00 �U � <br /> Repair Existing System 100.00 <br /> (Tanks or Drainfield) <br /> State Surcharge 5.00 5.00 <br /> � <br /> Tota I $ �/�'�.� � <br /> 1 /2 <br />