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I will be installing the following: <br /> �Tank <br /> ecast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 3 �h (�s s .e x:s-fi� �re 5 0�� <br /> Size of Tanks: dv ac� / 3o v <br /> Treatment System <br /> Trenches s.f. <br /> � Mound S`��4 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 /> � 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 /> Signature of Applicant Date: 5 — Z � ^ �� <br /> MPCA License No.: to �C� <br /> Staff Review: Accept 0 Denied <br /> Reviewer: � Date: � ��'�� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 2 � 2 <br />