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� ' � , <br /> ** ATTENTION APPLICANT*� <br /> Fill in all 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 manutacturer) <br /> Number of Tanks: 3 <br /> Size of Tanks: 1000 1300 1000 <br /> Treatment System <br /> Trenches s.f. <br /> X Mound 76 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 correct. <br /> Signature of Applicant 'L� ��t Date: 6-17-16 <br /> MPCA License No.: <br /> Staff Review: �J Accept Q Denied / <br /> � % f , <br /> � 7� 7/ '� <br /> Reviewer: !�� �:� �� � ��, <br /> _ ,�_ ��, Date:_� � <br /> � i <br /> Reason for Denial: <br /> Gomments (to be printed on inspection card): <br /> 2 /2 <br />