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** ATTENTION APPLICANT ** � � <br /> j Fill in all appropriate blanks and check all 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: (C�DO �(;)C�U �C�C7C7 <br /> Treatment System <br /> Trenches s.f. <br /> �/ Mound ��J s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> Final Cover / Top Soil <br /> e 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 /> n � ,�� <br /> Signature of Applicant ��-�-�---� �%C�C-�� Date: � � � � - �%�� <br /> MPCA License No.: <br /> Staff Review: (��Accept ❑ Denied <br /> Reviewer: �� Date: g � �� - � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 � 2 <br />