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. , <br /> ..„,,,,,,,,,,,4,'4,4,1:4:4'k' A NT-o . PLCANT s ti., <br /> F : a , " s3.rte 1pribos ; t; - illinllapprr pr,,ate blah s nd, eck1aprop . <br /> I will be installing the following: <br /> Tanks <br /> qPrecast Concrete ❑ Fiberglass 7 Plastic I I Other <br /> (list manufacturer) <br /> Number of Tanks: <br /> Size of Tanks: /7 .�U (00 0 (c725-0 <br /> Treatment System <br /> Trenches s.f. <br /> Mound s.f. ge-c-4-) C‘- • CS k-A c� 9s r-r— <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, ue and correct. <br /> Signature of Applicant ,�,��(, .� ii-/1 Date: Z - a ` 02 /i) <br /> MPCA License No.: /( <br /> Staff Review: X Accept n Denied <br /> Reviewer: Date: 6 -2•--( - to <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 2 / 2 <br />