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1 <br /> ',_ . + '''''',76T:771'.;:::,,:, 7‘'. 1-.7...77 ,‘..:,7". : 3,," ri <br /> kiti <br /> d, t 4 r 1;gr c€,, : ,1 r1 th. s ',..,1,L1Yp"t-'4 c <br /> I will be installing the following: <br /> Trs <br /> Precast Concrete 111 Fiberglass ❑ Plastic 111 Other <br /> (list manufacturer) <br /> Number of Tanks: <br /> Size of Tanks: /d00 / 6)c.9-0 ( P Y j <br /> Treatment System <br /> Trenches s.f. <br /> Mound S06 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 certifies that all statements made on this <br /> application are completeji nd correc . <br /> Signature of Applicant Date: �7 <br /> MPCA License No.: 0 3C-r Y L (p `/ 0 <br /> Staff Review: VI Accept ❑ Denied <br /> Reviewer: (,f/,6e.'L-LS'Lz.(.- Date: --,2L( — ( <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 />