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** ATTENTION APPLICANT** <br /> Fill in all appropriate blanks and check all appropriate boxes. <br /> I will be installing the following: <br /> Ts <br /> Precast Concrete E] Fiberglass ❑ Plastic F1 Other <br /> (list manufacturer) <br /> Number of Tanks: C9 <br /> Size of Tanks: JA5CPurTTU( <br /> Treatment System <br /> ❑ Trenches s.f. <br /> Mound DC7 s.f. <br /> 0 Gravel less s.f. <br /> Chamber s.f. <br /> Final Cover/Top Soil <br /> 0 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 5C6��*— Date: <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 /> Reset Form 2 / 2 VA(Permits)\Septic System Permit Application.doc <br />