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I ' <br /> i � v <br /> I will be installing the following: <br /> Tapks <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 3 <br /> Size of Tanks: 130d <br /> Treatment System x-1 si '�.5 I a 3 8 <br /> Trenches s.f. <br /> Mound (o `Za s.f. 10 x -Z- <br /> Gravel <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 /> '-] <br /> Signature of Applicant Date: 7- 7- QE- <br /> MPCA License No.: �. <br /> r'. <br /> Staff Review: Accep ❑ Denied <br /> Reviewer: 'A ol - Kl� Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 /2 <br />