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� <br /> . <br /> . <br /> - „ � .. � . , . , u � <br /> , <br /> � � _ . , <br /> , , , , <br /> . ; . ;� <br /> . , .�� : � _ <br /> : ,t _. � . �_ _ �. .�... ..�_� , �._ �_: , = k �� . .,; .� . <br /> ..- <br /> . .�.,u. sw ��.m� �� <br /> I will be installing the following: ' <br /> , <br /> Tank . <br /> recast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> � <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, tru ect. <br /> Signature of Applicant Date: �� —��^ �� <br /> MPCA License No.: L. � �C� <br /> Staff Review: �q►ccept ❑ Denied <br /> Reviewer: /i �.� ! ,��, Date: �������,� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:1(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />