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� <br /> ,.... <br /> n � r � � � . , _ , <br /> , � . <br /> . . > <br /> , 4 . _ , <br /> � . � � . <br /> . , : , �',nS. , �,�. <br /> �- :.� ;� _ � r�� <br /> � .. <br /> . < , �� " <br /> . <br /> , <br /> : �- -.���. .�,� ,. ;, ;� . E . . . �.,. _ � ��- .. .. �� .,u� �. <br /> I will be installing the following: <br /> Ta s <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � C^`1�1 S�`�`�� <br /> Size of Tanks: <br /> Treatment System ���ST� <br /> � <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 d re t <br /> Signature of Applicant Date: �� � � <br /> MPCA License No.: ���� <br /> Staff Review: ❑ Accept ❑ Denied <br /> Reviewer: Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />