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** *� � � <br /> � <br /> ATTENTION APPLICANT <br /> Fill..in all a ro riate blanks and check all appro 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: j �S� ( �.SC� ( iZSQ <br /> Treatment System <br /> � Trenches s.f. <br /> , ��� <br /> Mound 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 /> � <br /> tr�cked 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 correc <br /> Signature of Applicant ,�C� ����� Date: � � c��/ <br /> MPCA License No.: -� � � <br /> Staff Review: I�JAccept ❑ Denied <br /> Reviewer: �T,'+���,���,. ��`��I� Date: � �� j��� j <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 / 2 <br />