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r <br /> / <br /> . **ATTENTtQN APPLiCAN'T'�' ` , . , <br /> , -. <br /> : �iU in al1 a ro rfate blanks and check aH a � '�te boxes. � <br /> 1 will be insta�ling the following: <br /> T nks <br /> � Precast Concrete ❑ Fiberglass ❑ Pfastic ❑ Other <br /> (fist manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: /30 G j3 v o l.�oo <br /> Treatment System <br /> Trenches s.f. <br /> ,�_ Mound s,f. �3 � �/ <br /> Gravel less s.f. <br /> Charnber s.f. ������ <br /> �p ,k'�3 <br /> NOTE: The contract�r �s required to provide an As-Built of the system befo�e the <br /> final inspection. <br /> The undersigned hereby applies to the City of Orono for issuance of a sepfic system <br /> instaljation permit, agrees to do all the work in strict accordance with vrdinances of the City <br /> and regulatians of the State of Minnesota and certfies that all statements made on this <br /> app�ication are complete, true and correct. <br /> r .r <br /> Signature of Applicant / Date: � /'S <br /> MPCA License No.: e�l � � <br /> Staff Review: �] Accept ❑ Denied <br /> / ' <br /> Reviewer: �ate: <br /> Reason for Denial: <br /> Gomments (to be printed on inspection card): <br /> 2/ 2 <br /> Z'd L6ZLZL6£9L o�uosaa}ad�aawl3 e0£�06�6 Z6 �nd <br />