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** ATTENTIO'N APPLICANT ** - — � . <br /> i__ Fil! in all appropriate blan_ks and check all appropriate boxes. ' _ _� <br /> I will be installing the following: <br /> Tank <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 3 <br /> Size of Tanks: �� �' �-% �c����� /ucv c5 �r'�-f <br /> Treatment System <br /> Trenches s.f. <br /> � Mound �v� 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 /> applicati�n are complete, true and correct. <br /> _ , <br /> Signature of Applicant Date: g"� 2 r��=s <br /> MPCA License No.: � �L� <br /> Staff Review: [�], ccept ❑ Denied <br /> (/ <br /> Reviewer: ,�/ ;.i�, ��(� Date: �-J _ / 7 -e� <br /> Reason for DeniaL• <br /> Comments (to be printed dn inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 � 2 <br />