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** ATTENTION APPLICANT ** ! <br /> I <br /> Fill in ail a ro riate blanks and check all a ro 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: <br /> Treatment System <br /> Trenches s.f. <br /> - ,�_. _� <br /> �_ Mound �> 5 L' 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, true and rect. <br /> Signature of Applicant � Date: � S /C� <br /> MPCA License No.: �S � <br /> Staff Review: 0 Accept ❑ Denied <br /> � � � . <br /> _ . , <br /> . .._ <br /> Reviewer: �`;'',.. � u%�%�-,� Date: � -� � � U <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 2 � 2 <br />