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, , <br /> ** ATTENTION APPLICANT ** <br /> Fill in all a ro riate blanks and check all appropriate boxes. <br /> I will be installing th following: <br /> Ta s ( �� ��.��S.t.� , <br /> Precast Concrete � Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: 1�S �' <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: <br /> MPCA License No.: <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: ,/�J"_ �� t-C'., o,� Date:_ % (-�C)�c��7 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 / 2 <br />