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** ATTENTION APPLICANT ** � ', , <br /> ! Fill in all appropriate blanks and check alf 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 /> Size of Tanks: ��� j2.�� 'G%� <br /> Treatment System <br /> Trenches s.f. <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 and correct. <br /> � � ��� �� ,���`"��., <br /> Signature of Applicant � l Date: � / <br /> MPCA License No.: <br /> �� �T � <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: _ �� ��� '� Date:_ � �.�� �� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> _ �� ,��-r Sy`�-��u � �'�, � �/c� �3�' -- --�LS � A� <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 2 � 2 <br />