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'�a � ,�a �S� �X"� .. -�� a? � '� �� 4 ' X� -�F� q �'�.�,� ��P'i� <br /> � y }- y�'`�' � �,��i���,a� �li 3. �2x� � � �`E ��`",�, / � gha � �'�ro h� � ap � � �f <br /> �. � �.r � °� �r, '� '�' � .�."z� �v•:: � � t s,,��,� "�.�•_ <br /> � �va ':}�.I„ ''�} 'f� � <br /> I will be installing the following: <br /> Tanks <br /> ❑■ Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 3 <br /> size of Tanks: 1000 1000 1000 <br /> Treatment System <br /> Trenches s.f. <br /> X Mound 46x82 s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> NOTE: The contractor is required to provide an As-Built of the system before the <br /> final inspection. <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 correct. <br /> Signature of Applicant ^- ate: 9����201� <br /> MPCA License No.: �888 <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: Date: �'�� �" !� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> � � <br /> � � <br /> .� . . .. ... . ,�. <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 �2 <br />