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� <br /> ** ATTENTION APPLICANT ** —' <br /> i _ Fill in all a��ropriate blanks and check all appropriate boxes. <br /> I will be installing the following: <br /> Tanks <br /> ❑ Precast Concrete Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: �- <br /> ��. <br /> Size of Tanks: �jiJ� (�(J(J <br /> Treatment System � <br /> � Trenches �- s.f. ����"� <br /> , � ��(�ti'.X�� <br /> Mound s.f. <br /> Gravel less s.f. <br /> _� Chamber s.f. <br /> Final Cover/ Top Soil <br /> � to be borrowed from site (show location on site plan) <br /> trucked in <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 an correct. <br /> I � <br /> Signature of Applicant �l lV\�1C�— Date: � ��J l� <br /> MPCA License No.: � 3"� �, ,.,��� ����'!�-i��J� <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: �� ��y� �ate: '�'�.�— 6 � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 � 2 <br />