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**ATTENTIC1 <br /> 5 4* <br /> Irl1 in al1`a ro riate blanks and check all'a ry date boxes. ° <br /> .; : <br /> I will be installing the following: <br /> Tanks <br /> ❑ Precast Concrete ❑ Fiberglass Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 02 <br /> Size of Tanks: <br /> Treatment System <br /> tS � Trenches s.f. <br /> Mound 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 jorld correct. <br /> 1/7 <br /> Signature of Applicant Date: S <br /> MPCA License No.: �a- <br /> Staff Review: ❑ Accept ❑ Denied <br /> Reviewer: Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />