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� <br /> .. <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 /> Tanks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: �� `— <br /> Size of Tanks: i� Qr� l aQd D d O <br /> Treatment System <br /> Trenches s.f. <br /> l� � <br /> Mound �°6 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 corre . <br /> Signature of Applicant �� Date: � `a � ( <br /> MPCA License No.: �`' C� � <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: r / ,. l �� l/'i�� Date: � ""�� '� � � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): �1/��.� � U� ��� � � � <br /> �� �' S�f � � C{ e c� � l-'--�v �s e .�1/tv 5 i �3 C �-��K e c' �.�. � <br /> �� c-� S �-1 S �t-�°�� <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 � 2 <br />