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, FOR CITY USE ONLY <br /> . ��ON City of Orono <br /> � P P.O. Box 66 °� <br /> 2750 Kelley Parkway Date Received: ���� <br /> Crystal Bay,MN 55323 Permit# ��5 �7�'" ����;/V <br /> y �,� Phone:(952)249-4600 <br /> f��Kxsxo'��' Fax: (952)249-4616 Approved By: <br /> Amount$: �� � <br /> Ch� i�1 �U�✓� � �.27� <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 /> ��° : � . � " 1 Owner Informatio � <br /> Site Address: 1070 Hunter Drive Orono <br /> Owner: Scott and May Gronholz Mailing Address: 120 Truffula Trail <br /> City: Orono Zjp: 55356 <br /> Home Phone: Alternate Phone: <br /> ��ractor I Applicar�t lnforma#ion: <br /> Contractor/App: Bohn Well Drilling, CO. ContaCt Person: Charlie Bohn <br /> Address: 18190 Dairy Lane State License #: 1043 <br /> City: �ordan Zjp; 55352 Expiration Date: <br /> Phone: 952-445-4809 Alternate Phone: <br /> TYPES OF OCCUPANCY <br /> � Residential ❑ Commercial ❑ Other <br /> *� �►��'��i�'ION APPLICANT** <br /> � Fill in all appropriate �alanks and check all appropriate boxe�. <br /> Tanks: <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other: <br /> Number of Tanks: 2 /�� ��� <br /> Size of Tanks: 1250 —�989—� �.Pump <br /> Type of Activity• <br /> ❑ Trenches � Moun ❑ Pressure Bed ❑ Chambers ❑ Holding Tanks <br /> ❑ Pre-Treatmen Other <br /> NOTE: Provide an As-Built of the system before the final inspection. <br /> A 24-HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. <br /> Page 1 <br />