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** ATTENTION APPLICANT *�` <br /> Fill in a!1 a ro riate bianks and check all a ro riate boxes. <br /> y C — �% S i"`� <br /> I will be ins�ing the following: <br /> T nk <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � 7.����� S�/�rf <br /> Size of Tanks: ����� ��O 2,(�0(� <br /> Treatment System <br /> 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 d correct <br /> Signature of Applicant ���-� Date: � �� ,`, <br /> MPCA License No.: � (l> �C� <br /> Staff Review: Accept ❑ Denied <br /> � ` <br /> Reviewer: �z� Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />