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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 ks <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: <br /> r�- i.�S.� �--I Uo� ►� wa�v'` <br /> Size of Tank . �� +'� , '� � `��� a'y'� <br /> G� I r� o`2-YI�Q,vu" 30Q �- . �' ��l �� <br /> � <br /> Treatment System <br /> TTenches s.f. <br /> ' ,�r- <br /> ��Mound ��Z S 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 hereb applies to the City of Orono for issuance of a septic system <br /> installation permit, agrees t do all the work in strict accordance with ordinances of the City <br /> and regulations of the 'Sta of inn ta an certifie that all statements made on this <br /> application are complete tru and rrect. <br /> Signature of Applicant Date: ��� "l� <br /> MPCA License No.: �� <br /> Staff Review: 0�cept ❑ Denied <br /> � <br /> Reviewer: �[,�--�- .�.�C.��;�'� Date: > " <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> "�-; N � �,�(���� �C; I� � ( �" (�,�," �i� � �� �� �� <br /> `�� ��-t�1 t i� -f--��'� <br /> W:\(Applications,License or Permit Applications)\Permits\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />