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, � ' <br /> ** ATTENTION APPLICANT ** <br /> Fi!! ir� a!E a ra rGatE blar�k� artd ch4ck a!! �. ro r��.tE ls�xE�. <br /> I will be installing the foilowing: <br /> Tan ks <br /> [�Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanlcs: --? �� �c; ��t �L��� �, i= t- T-; �. {� <br /> Size of Tanks: r�--�--r�-� �'=���C-� �� c' <br /> Treatment System <br /> Trenches s.f. <br /> ,7� Mound -� �� 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 und�rsigned 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. �,�C r �. �j.a�, � ��;G J� � <br /> Signature of Applicant � � Date: ��/� � �� <br /> MPCA License No.: � 1�6� <br /> Staff Review: � Accept ❑ Denied <br /> Reviewer: �(,l� �iate: /'' � � -'�3 <br /> Reason for Denial: <br /> Comm�n�.s �#n �Q }�rint�d 9n in�p��#ic�n ��rc�): �� �yC.iS �-�nS �—IC3f�fiD ���" <br /> ��rC.S �CCr �e -cs s�c�� �Lti1 ��. �Cb �rH-� tta,�J �A-.� K is <br /> /l3�'T /IJC�CeS'S�--r`.1.-- �' l(373� 9� �, � rF-�' <br /> �S �e�.�`� . <br /> W:\(Applicatioiis,Liceiise or Pen�iit Applicatioiis)\Per�iiits\Septic Peniiit Applic;atiun-Upciated Surcf�arge 07-28-11.dac <br /> 2 � 2 <br />