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will be installing the following: <br /> Tanks <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of TanksC22 L')16Za a 1 x 's41`n� 1 L. 0-- <br /> Size of Tanks: 0e0 .c �;,�� a ,�, �r,.s� GY�c� C„z �,✓ <br /> Treatment System <br /> \/ Trenches / s.f. <br /> K Mound 3 �� s.f. <br /> Gravel less s.fJ <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 and correct. <br /> Signature of Applicant Date: <br /> MPCA License No.: 7 <br /> Staff Review: [Accept ❑ Denied <br /> Reviewer: i Date: - ) 0-to <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Se tic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 / 2 <br />