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. � <br /> � ** ATTENTION APPLICANT ** <br /> '� Fill in all appropriate blanks and check all appropriate boxes. <br /> I will be installing the following: <br /> Tanks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: G r, t <br /> Size of Tanks: /6 � C"� <br /> Treatment System <br /> Trenches s.f. � <br /> Mound s.f. - � <br /> /�,I� <br /> Gravel less s.f. <br /> � � <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 /> application are complete, true and correct. <br /> Signature of Applicant �� Date: �� �G -�� <br /> MPCA License No.: __`,� � � <br /> Staff Review: `"�J Accept ❑ Denied <br /> � � <br /> Reviewer: , Date: � - l0 ' C�� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 / 2 <br />