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� <br /> � <br /> '�* ATTENTION APPLlCANT '�� <br /> Fiil in all a ro riate blanks and check all a ro riate boxes. <br /> I will be installing the following: <br /> Tanks <br /> �f Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> � <br /> Number of Tanks: �x- 5���^� <br /> e— <br /> Size of Tanks: <br /> Treatment System <br /> �{�t 5'S � � • _� f''�ss������ ��. � s.f. <br /> /1 � Mound s.f. <br /> i ;yc <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 � Date: � "L� -- �� <br /> MPCA License No.: `` �q <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: — Date: � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />