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�" � � � *�` ATTENTIO�N APPLICANT ** ,�� �'' . <br /> i Fill in all appropriate_blanks and check all appropriate boxes. <br /> s <br /> I will be installing the following: <br /> Tanks <br /> ❑ Precast Concrete ❑ Fiberglass � Plastic ❑ Other <br /> (list manufacturer) <br /> —� <br /> Number of Tanks: � <br /> Size of Tanks: /C)Od /�� �Q�Q <br /> Treatment System <br /> Trenches s.f. <br /> 4� Mound ;;� � C'� 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 /> appfication are complete, true and correct. <br /> Signature of Applicant Date: /- 3p - d 9 <br /> M PCA License No.: ���(��� <br /> Staff Review: [��Accept ❑ Denied <br /> J , �Reviewer: /� � `� ;�'.��-C ;-��,� Date: ��t�C� q <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 � 2 <br />