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, , <br /> ** ATTENTION APPLICANT ** -� <br /> � <br /> �� Fili in all appropriate blanks and check all appropriate boxes. I <br /> I wilt be installing the following: <br /> Tanks- <br /> �Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: ��^�-u-'t`'� 1.�.�-,�<<, ,',.. —' , <br /> �� <br /> Size of Tanks: <br /> Treatment System <br /> Trenches s.f. � <br /> Mound s.f. <br /> ` Gravel less . s.f. <br /> �,amber s.f. <br /> �. <br /> _ �� <br /> � <br /> Final Cover/ Top Soil., <br /> .�� <br /> , to be borrowed from si how location on site plan) <br /> �-.`_ <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 and correct. <br /> -�--� ___. <br /> Signature of Applicant Date: �� Z� �� <br /> MPCA License No.: � � �_� <br /> Sta�f Review: Accept ❑ Denied <br /> Reviewer: ��.�t� Date: ��� ��� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 2 � 2 <br />