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. •' � . <br /> *'� ATTENTION APPLICANT ** <br /> Fill in all a ro riate blanks and check all a ro riate boxes. <br /> I will be installing the following: <br /> an�s <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> i (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: U�� � �� <br /> Treatment System <br /> Trenches s.f. <br /> � Mound � � 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 rect. , <br /> , <br /> Signature of Applicant Date: � `�� � � <br /> MPCA License No.: �C�� <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: � � � � Date: ��� (� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />