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&Y OF ORONO PERMITPERMIT TYPE: <br /> 2750 Kelley Parkway- P.O. Box 66Permit Number: WHT R <br /> Crystal Bay, Minnesota 55323 <br /> (612)473-7357 Date Issued: 05 c,l3-. <br /> SITE ADDRESS: <br /> 1020.-`t i TOWNL I NE RD <br /> .TC <br /> P. I . N . , 3o- <br /> DESCRIPTION: <br /> =ewer h Water Permit. Type: NEW `::;EF'TIC <br /> Sewer & Water Werk: Type RESIDENCE <br /> REMARKS: <br /> FEE SUMMARY: <br /> Base Fee $100 ii}. 00 <br /> Surcharge -_-___ _I-5Q <br /> -$ <br /> Total Fee 100 .50 <br /> CONTRACTOR: - Applicant - ST . t I C . OWNER: <br /> INDEPENDENT`ENDENT SEPTIC SYSFEt sS .5479:=:3:64 .342- L i�N I ESK I TOM <br /> z = CO RD 90 1020 TOWNL..I NE FAD <br /> MAPLE PLAIN MN =5_-5`� 's=i}=RNC MN 5,5�:5°� <br /> (61 2) 479-3364 <br /> 64 <br /> THE UNDERSIGNED HEREBY REQUESTS PERM I SSI 0N TO MAKE SHF.. REAL. . 0-430VEMENTS <br /> SPECIFIED AND AGREES TO 00 ALL WOR IN"STFiIT � ' CITY r <br /> i RONr� ORDINANCES AND STATE `1F 19 I NNESDT t BU I LD I NS <br /> APPLICANT/PERMITEE SIGNATURE 0 ISSUED BY:SIGNATURE <br />