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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 /> T nks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � <br /> �,(;s h� 2�C i s�`� .�c�C:� h-e�✓ <br /> Size of Tanks: i d��-, /o�e �Opo 1,�F <br /> Treatment System <br /> Trenches s.f. <br /> ✓ Mound S�U S,f, fv '�S� <br /> Gravel less s.f. <br /> Chamber s.f. <br /> Final Cover/ Top Soil <br /> to be borrowed from site (show location on site plan) <br /> t/ 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 correct. <br /> � <br /> Signature of Applicant � Date: `t — ZS'u� <br /> MPCA License No.: (n ��} <br /> Staff Review: �Accept ❑ Denied <br /> ' ���� �'� 9� .� � � <br /> Reviewer: �,1'� Date: � ` C� <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 />