Laserfiche WebLink
, r � <br /> ** ATTENTIQN APPLICANT** <br /> Fill in all a ro riate blanks and check ail a ro riate boxes. <br /> I will be installing the following: <br /> Tanks �) <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other ,c�'�',1'� ��Ui4��= <br /> (list manufacturer) <br /> Number of Tanks: ��"'� �a���� �� ��7�-- <br /> Size of T�anks• �.5�> .5�� ���L� <br /> .� �T��'G� �'�!«f'� j �„� �t�1�� ��,�' �1s�J� � �i � � <br /> �����/l��' /t�,��C C���7,� �l�/t- . , - <br /> Treatment�stem � <br /> �ir'.�'Ir� ���� � s.fi. "�oI/f� �� ls� ,�i�'��T <br /> !��� ���t�� <br /> 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, tru� and corr t. C�� <br /> /���.� / /� �`'r� <br /> Signature of Applicant——- _.�--- ��ti�� O��- Date: ��'�- � <br /> �- <br /> MPCA License No��'�.l���f �� l�`���� <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: / '�� Date: (�' `'��"� ' I� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> Reset Form <br /> W:\(Permits)1Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 /2 <br /> _ . r <br /> t � <br />