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• <br /> • <br /> 8 g , ., 3 4 m ® '"yup �+�, y <br /> I will be installing the following: <br /> T n s <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: �.�rwrv� <br /> ve`05.e u /�,,1 <br /> Size of Tanks: (OCA i C / I <br /> Treatment System <br /> Trenches s.f. <br /> Mound 3 s.f. v X 3S <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 an rrec . <br /> Signature of Applicant Date: ( a Z ' - <br /> MPCA License No.: 4-- <br /> Staff <br /> —Staff Review: Accept ❑ Denied <br /> Reviewer: .,6 �� Date: l (. /—/ <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 />