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,1 <br /> �' **ATTENTION APPLICANT ** <br /> � <br /> a a !+ S <br /> f y <br /> �1n 4alba ro,' rIate.bManks `nd check all'`a r`o riat'e boxes: <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: OUZO ��9OU b <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 re <br /> Signature of Applicant Date: —7 Z I �-- <br /> MPCA License No.: <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: Date: —7- 3—tv2 <br /> :z <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11 <br /> 2 / 2 <br />