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** ATTENTION APPLlCANT ** I ' <br /> , , . <br /> � Fill in all appropriate blanks and check all appropriate boxes. j <br /> I will be installing the following: <br /> Tanks <br /> n Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> �"�. <br /> (list manufacturer) <br /> 1Number of Tanks: � <br /> Size of Tanks: i 3��c� �• 3 ��� /�c�v /, '{�- <br /> Treatment System <br /> Trenches s.f. <br /> �-� Mound v��-� <br /> s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> Final Cover/ Top Soil <br /> to be borrowed from site (show location on site plan) <br /> V'"�� 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 correct. <br /> ;______._,.. <br /> ______..___ . <br /> Signature of Applicant - �� Date: � �- Z 5 —U � <br /> MPCA License No.: <br /> � �� �� <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: ,�'e�� , ��i� Date: (D ,�� '�� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> ��/l�? ��� G� � �� �� �� , ,�! r ,��'c+ j � '� � � ' '� <br /> ��`� �'SS��a�� � ��R��.. <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 2 � 2 <br />