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� ** ATTENTION APPLICANT ** i , <br /> Fill in all appropriate blanks and check all appropriate boxes <br /> I will be installing the following: <br /> Tank r <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other �v�-L S <br /> (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: %�%C�C� j(���C� %C� oci <br /> Treatment System <br /> Trenches s.f. <br /> h <br /> Mound / Q s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> Final Cover / Top Soil <br /> to orrowed 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 correc . <br /> �—_ <br /> Signature of Applicant Date: � <br /> MPCA License No.: ��� <br /> Staff Review: Accept, ❑ Denied <br /> Reviewer: �' � <br /> , �, <br /> - Date: 1 � ` � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 / 2 <br />