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♦ <br /> ♦ <br /> �`*ATTENTION APPLICANT ** � <br /> � Fill in alf appropriate blanks and check all appro riate boxes. <br /> I will be installing the following: <br /> T s <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> Qist manufacturer) <br /> Number of Tanks: 7 Z�;c�S�{�Jo� jo�s �v4 c�l,t, <br /> �2�j 5�� S� /�GQ(X <br /> Size of Tanks: l�C'J l��v /eo�,�Oc � 2X� ' � <br /> Treatment System �`L����,..� <br /> Trenches s.f. ��� �f� � 7 <br /> r�'`�' �`� <br /> � Mound U �U s.f. ( � � � S 5or I ��` <br /> � � � �� ^ �� <br /> Gravelless s.f. .1- "`J ����. <br /> � <br /> �`r `'�-�J �-�'�"�� .-� <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 rrect. <br /> �— <br /> ` .-------.__ _ /� ��o — (�_ <br /> Signature of Applicant � Date: <br /> MPCA License No.: <br /> � � �� <br /> Staff Review: ' Accept ❑ Denied <br /> Reviewer: �" � Date:_ � � � :3G `� �� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />