Laserfiche WebLink
+ • M <br /> ' **ATTENTIQ�V APPLICANT** <br /> � Fill in all appropNate blanks and check aW approp�ate boxes. i ' <br /> I will be installing the following: <br /> Tanks <br /> ❑ Precast Concrete ❑ Fiberglass ❑ Plastic ther <br /> (list menufaIXure� <br /> Number of Tanks: � <br /> Size of Tanks: "" <br /> Treatment System G�- ���?�'m' ��-''` , � ��rJ �l�. <br /> Trenches s.f. ��,��,�• -� ((�(��,,�..QlZ. <br /> Mound s.f. � <br /> Gravel less s.f. <br /> Chamber s.f, <br /> NOTE: The contractor fs required to provlde 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,t nd correct. <br /> : <br /> Signature of Applicant '" -� ,$�.�.�_ � Date: /d-!(p- !3 <br /> MPCA License No.: <br /> Staff Review: ❑ Accept ❑ Denied <br /> Reviewe�: Date: <br /> Reason for Denial: <br /> Comments(to be printed on inspection card): <br /> W:\(Applications,License or Pertnit Applications)�PermitslSeptic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2�2 <br /> � r . ., <br />