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; ** ATTENTION APPLICANT ** �T� "' • . <br /> � <br /> _ Fill in all appropriate blanks and check all appropriate boxes. <br /> I will be installing the following: <br /> Tanks <br /> ❑ Precast Concrete �l( Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: --' <br /> Size of Tanks: %vo�� /cv c? <br /> Treatment System , <br /> Trenches s.f. \ <br /> Mound s.f. <br /> ravel 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 /> ,; �� �;-'�... . __ -- , � U <br /> Signature of Applicant � --- Date: �- �" � �" <br /> MPCA License No.: <br /> Staff Review: �(�Aecept ❑ Denied <br /> �- <br /> `� '�� �'�� <br /> Reviewer: - - Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 � 2 <br />