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: k• ., .,: .Y.. 3 v .i <br /> Fill in all a• •ro•riate _ ,• <br /> 1 will be installing the following: <br /> Tanks N <br /> 5. Precast Concrete LI Fiberglass 111 Plastic [^ Other <br /> (li manufacturer) <br /> Number of Tanks: <br /> Size of Tanks: I <br /> Treatment System <br /> Trenches s.f. <br /> Mound 'SU X 3 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 complete, true and correct. <br /> Signature of Applicant Date: 7/3//z/ <br /> MPCA License No.: / <br /> Staff Review: Accept .❑ Denied <br /> Reviewer: Date: ViCs//7 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Applications,License or Permit Applications)\Permits\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 / 2 <br />