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SKETCH: licensed site evaluation, design, sketch and management plan with <br /> application. <br /> pplication. If substantial changes are made to the design during installation, a new design <br /> must be submitted with the date and designer's signature prior to installation and inspection. <br /> Completed Site Evaluation lkl[Sles UNo Date I tit <br /> Completed Design Worksheets Wes E)No Date I o 3-At <br /> Compliance Inspection Wes UNo Date 61z/? <br /> Management/Monitor Plan ilYes UNo Date Approved IpIL -14 <br /> AGREEMENT. INVe the undersigned, hereby make application for work described and located <br /> as shown herein. IMe certify that the information contained herein is correct and agree to do <br /> the work in accordance with the provisions of the Orono City Code and the State of Minnesota <br /> MPCA Rules 7 4._jpe further agree that any plans, specifications, or drawings <br /> .n <br /> t <br /> subi ,itted h th a carat nd shall become part of the application. <br /> 19134L"# <br /> I SignattVe-of Homeow�ne-r7W�-�ent Date <br /> PERMIT. Permission is hereby granted to the above named applicant(s)to perform the work <br /> described in the above application. Any and all changes to the approved design shall be <br /> reported to the designer and to the permitting agency prior to the completion of the work. This <br /> permit is granted upon the express condition that the person to whom it is granted, and his/her <br /> agent, employees and workers shall conform in all respects to the Orono City Code and the <br /> State of Minnesota 7080-7084 Rules. This permit may be revoked at any time upon violation <br /> of said ordinances and codes. This permit expires on December 31 of the year in which it is <br /> issued. This permit, with all supporting documents,will become a permanent part of the <br /> property records on file t the Orono City Hall. <br /> Communit*Developr6`ant Director or Designee Dak I <br /> Return this Application to: <br /> Physical Address: Mailino Address: <br /> City of Orono City of Orono <br /> 2750 Kelley Parkway P 0 Box 66 <br /> Orono, MN 55356 Crystal Bay, MN 55323 <br /> Phone .-952-249-4600 www.ci.orono.mn.us <br /> Fax: 952-249-4616 amackiMci.orono.mn.us <br /> Septic Permit-Revised 7/812014 Page 2 of 3 <br />