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a:� <br /> ' � � ,r,;04 <br /> arae antwan' APP 0prla k . <br /> I will be installing the following: <br /> T^an�k <br /> Precast Concrete (l Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 3 <br /> Size of Tanks: ( 30 o i cio 3 o0 <br /> Treatment System <br /> Trenches s.f. <br /> Mound cDG s.f. <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 /> Signature of Applicant ' ' ° <br /> 9 pp Date: 7 <br /> MPCA License No.: (c cj <br /> Staff Review: ( Accept ❑ Denied <br /> Reviewer: „At.) �, ;�, L Date: 1- 17 o <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 />