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, • , <br /> ** ATTENTION APPLICANT ** • <br /> Fill in all a ro riate blanks and check all a ro riate boxes. � <br /> I will be installing the following: <br /> Tan s <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: .� <br /> Size of Tanks: �S � Ci � �� <br /> /� f.� � / Sl; <br /> Treatment System <br /> Trenches s.f. <br /> J� Mound - � 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 /> 1 <br /> Si nature of A licant ��- � Date: <br /> 9 P P ;� ���l� `��.. �C� <br /> \ <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)\Septic Permit Application-New Permit Fees 2009.doc <br /> 2 / 2 <br />