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� ` ` ' ** ATTENTIO�N APPLICANT **' ;��" <br /> l� � � �� ' e'� 5 � �r�� <br /> `' �. F:ill in all a �° ro ria"te blanks"and check all a �`ro �riate boxes.l <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� �� � �v<<�« /o� � i r�'f <br /> Treatment System <br /> Trenches s.f. <br /> � MOund S v v Scanned <br /> 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 /> applicatian are complete, true and correct. <br /> _ , <br /> Signature of Applicant Date: �� 2 ��'�� <br /> MPCA License No.: �p �L� <br /> Staff Review: ccept ❑ Denied <br /> Reviewer: ,�( J /c,� Date: � ' � 7 "� <br /> Reason for DeniaL- <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)1Septic System Permit Application.doc <br /> 2 � 2 <br />