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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 manufacturer) <br /> Number of Tanks: 3 <br /> size of Tanks: 1500 1500 1500 <br /> Treatment System <br /> Trenches s.f. <br /> X Mound 4�X85 s.f. 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 d correct. � <br /> "�— 6/13/11 <br /> Signature of Applicant Date: <br /> MPCA License No.: � $88 <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: � Date: � - ! � �� 1 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> Reset farm <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 � 2 <br />