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I will be installing the following: <br /> Ta ks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: � � � ��� <br /> Treatment System <br /> Trenches s.f. <br /> � Mound `73,X -1 � r �r�s3 Coo��� <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 /> . <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 correc . ` ���/y,, �� - <br /> � ��U� <br /> Signature of Applicant �� Date: �— ��/� <br /> MPCA License No.: l�� <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: �� ��� � Date: �� �" � 7 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Pe�rnit Application-Updated Surcharge 7-1-10.doc <br /> 2 � 2 <br />