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; ** ATTENTION APPLICANT ** <br /> Fill in all ap ro riate blanks and'check all a pro riate boxes. <br /> I will be installing the following: <br /> Tan <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 3 <br /> Size of Tanks: f C�V ((7C��j IL�C�G <br /> Treatment System <br /> Trenches s.f. <br /> v Mound ��U 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 /> Signature of Applicant Date: j-��-�}�� <br /> MPCA License No.: �(��}�,-, <br /> Staff Review: Accept ❑ Denied <br /> .� . � � . U� <br /> Reviewer: _��c.�� ��� 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 />