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** ATTENTION APPLICANT ** <br />Fill in a!I appropriate blanks and check all aaaaaaaapropriate boxes. <br />1 will be installing the following: <br />Tanks <br />9 Precast Concrete ❑ Fiberglass <br />Number of Tanks: <br />Size of Tanks: <br />Treatment System <br />Trenches <br />Mound <br />Gravel less <br />Chamber <br />s.f. <br />_ s.f. <br />s. f. <br />s.f, <br />❑ Plastic ❑ Other <br />(list manufacturer) <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: <br />MPCA License No.: -/ <br />Staff Review: '❑ VAccept _ ❑ Denied <br />Reviewer: _f Date: <br />f . <br />Reason for Denial: <br />Comments (to be printed on inspection card); <br />v v_ <br />,t='' 2/2 <br />