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,r . 1 <br /> ` ** ATTENTION APPLICANT *�` - `44*y�' ` <br /> s <br /> _ _ Fill in all appropriate bianks and check all appropriate boxes. _ <br /> I will be installing the following: <br /> Tanks <br /> ❑ Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: <br /> � <br /> Size of Tanks: <br /> Treatment System �����.� .�— <br /> Trenches s•f• �� �'I /1 r��� �� <br /> UC <br /> _� Mound s.f. <br /> � :.__.r.._..�._._---...�.�__......._._____.... � <br /> Gravelless s.f. ��� b-e-� ��� � �-e <br /> Chamber s.f. <br /> Final Cover/ Top Soil <br /> to be borrowed from site (show location on site plan) <br /> �? trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system <br /> installation permit, agrees to do all the work in strict accordance with ordinances of the City <br /> and regulations of the State of Minnesota and certifies that all statements made on this <br /> application are complete, true and orrect. <br /> ---- ----� <br /> Signature of Applicant Date: � ' 7 ' L'�� <br /> MPCA License No.: � � � <br /> Staffi Review: �t Accept ❑ Denied <br /> Reviewer: �( �r[� !'�yL-� Date: 7— �� � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> �C�!�•-t �A C �tc7 r (_.��) �1� �� 1�[..� l.� (�i�.�) -}t � S .il c-�� S S A r�l. <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 � 2 <br />