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*�` ATTENTION APPLICANT""� <br /> Fill in all a ro ria#e blanlcs and check a!1 a ro ria�e boxes. <br /> r r - �5 � ,� i ,t� ;�, �� c�. <br /> i will be i�Fling the following: <br /> a ks <br /> ' Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � � £� K` 5`�`'":°� <br /> Size of Tanks: /��'� /� � �� /��`-'� <br /> Treatment System <br /> Trenches s.f. <br /> � Mound L'�� s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> NOTE: The contractor is required to provide an As-Built of the system before the <br /> final inspection. <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 of Applicant Date: `r Z � �� <br /> MPCA License No.: �-- �`� U <br /> Staff Review: cept Denied <br /> Reviewer: � Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />