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� <br /> �`* ATTENTION APPLICANT ** <br /> Fill in all a ro riate blanks and check ali a ro riate 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� Bv /l9-t�0 �� <br /> Treatment System <br /> Trenches s.f. <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 d rrect. <br /> Signature of Applicant Date: 7 Z v ^ � � <br /> MPCA License No.: � �� <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: � � � �( i�— Date: �'-� � � � � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 � 2 <br />