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�"� ATTENTIQN AP'PLICANT ** <br /> Fill in all a ro riate blanks and check all a ro riate baxes. <br /> I will be installing the following: <br /> Tanks <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 �� - 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 correct. <br /> Signature of Applicant ��'�`�J�'�`-�--�-� Date: � �� �� S ' <br /> MPCA License No.: �.��`I <br /> Staff Review: �Accept ❑ Denied <br /> � <br /> Reviewer: Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): �� •,,� <br /> , . . � ; ,b�� <br /> �- � � � �- <br /> �� ,nn 2 �2 <br /> U�`'" <br /> rr ' <br />