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'*'* ATTENTION APPLICANT *� <br /> Fil� in ail a ro ria#e blanlcs and check a!1 a ro riate boxes. <br /> I will be installing the following: <br /> T s <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> � <br /> Number of Tanks: � <br /> Size of Tanks: � �"SZ� �"'�� �'�' � �C�Z' �r � <br /> Treatment System <br /> Trenches s.f. <br /> Mound �G1 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 reguiations of the State of Minnesota and certifies that all statements made on this <br /> application are complete, true and ar�ct. <br /> Signature of Applicant —' Date: /C%/�- /S� <br /> MPCA License No.: �--� ( � <br /> Staff Review: Accept ❑ Denied <br /> � <br /> Reviewer: Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): �Xdas2� �Cc S7'���� /^�C��G���! <br /> � rd�� 1� Zz, <br /> 2 � 2 <br />