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)x' <br /> Fil i 'all a ro ria a inn s ar ' c e A 'a ro ria ` <br /> I will be installing the following: <br /> Tanks �w Aj <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other D4 <br /> (list manufacturer) <br /> Number of Tanks: <br /> Size of Tanks: 0 � C cc <br /> Treatment System <br /> Trenches s.f. <br /> Mound 3 000 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 ��`�" `t.� Date: (_�2 -1 ('13.. <br /> MPCA License No.: v� <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: Date: c " i,2- (3 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> '9Q UCS" (re d A 4-- 4-1 .A.�_e <br /> 0 F TA s 4c r/I- -h'dA-f , <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 / 2 <br />