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� � <br /> ** ATTENTION APPLICANT** <br /> Fill in a!1 a ro riate blanks and check a11 a ro riate boxes, <br /> I wili be installing the following: <br /> Tanks <br /> ❑ Precast Concrete ❑ Fiberglass ,�, Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: � !� "; �� � '� '' "� �, �% � ��� <br /> ,� <br /> . , , <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, true and correct. <br /> ,��'--- , / <br /> Signature of Applicant .�-_��� � �!� Date: ���-�/J/�� <br /> .,�- <�-�,� <br /> MPCA License No.: ./-' —� J �-- <br /> Staff Review: ❑ Accept ❑ Denied <br /> Reviewer: Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />