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.'� . � <br /> . �t , , <br /> ; ** ATTENTION APPLICANT ** . <br /> Fill in ali appropriate blanks and check ali appropriate boxes. j <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: �d� C�� � G{���64 � � �4� <br /> Treatment System <br /> �hes ;;';' � �� <br /> Mound s.f. ��-Q � <br /> � � <br /> /� � � <br /> Grave s s.f. �l�` ^ <br /> Chamber S.f, � l �` <br /> -~ � <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 ai Appiicant G � Daie: �� 0 <br /> MPCA License No.: __���� <br /> Staff Review: '�Accept ❑ Denied <br /> Reviewer: ✓ � � �� Date: �'� �:� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)1Septic System Permit Application.doc <br /> 2 �2 <br />