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** ATTENTION APPLICANT'S- <br /> Fill in all appropriate blanks and check all appropriate banes <br /> I will be installing the following: 'l k)S V �' '� Vt--9/y <br /> Tanks <br /> ❑ Precast Concrete ❑ Fiberglass ❑ Plastic n Other <br /> (list manufacturer) <br /> Number of Tanks: <br /> Size of Tanks: <br /> Treatment System <br /> Trenches s.f. <br /> y', <br /> Mound (o 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 c ifies that all statements made on this <br /> application are complete, tru ;i:nd7gect+ <br /> Signature of Applicant v _te Date: 03// <br /> MPCA License No.: <br /> Staff Review: ❑ Accept ❑ Denied <br /> Reviewer: Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />