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. <br /> � ��i'T��T���P:LICi�iNT *�` � . . , ' <br /> - �i�1�:.im ar��.'°, � ;i�o�,r�a��:bta�ks ar�t�ch��k���.a; �ro,�. '�a�e;boxe�. <br /> I will be installing the following: <br /> Tank <br /> Precast Concrete ❑ Fibergiass ❑ Plastic ❑ Other <br /> ��� ���, l 2�� t.� �� pist manufacturer) <br /> J <br /> Number of Tanks: <br /> Size of Tanks: <br /> Treatment System <br /> Trenches s.f. <br /> ✓ Mound � s.f. �o�,� ���, J� � � 3 <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 corr <br /> Signature of Applicant � Date: � � � � — ( `Z_. <br /> MPCA License No.: �l� `�� <br /> Staff Review: Accept ❑ Denied <br /> �1'� � ll�- �-r� <br /> Reviewer: Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): � .1� S Pi-�J c c� ��' <br /> ���'����' �' ��' �'�SPecef-- A/t��ti� �S�v� ��' <br /> �/A" ��i cf�` � �0 � � � /'��/''i �� �� � d`� �V i r��� <br /> � �c�� �{'PA/-.�� <br /> W:\(Permits)\Septic Permit Appliption-Updated Surcharge 07-2&11.doc <br /> ��- � � /� g�— � 2 /2 <br /> �C�;�i��' j�r s� /' � �'�-S� t �-��c�/�� <br />