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** 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: � <br /> Size of Tanks: /Z J� <br /> Treatment System <br /> Trenches s.f. <br /> \( Mound � 3 Z 3 s.f. /c� �l 6 3 ' ���� l� B�> c� . <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 /> ` ��' <br /> V 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 an correct. <br /> , / ��� <br /> Signature of Applican�' Date: Z � o <br /> MPCA License No.: �3 � <br /> / <br /> Staff Review: [�Accept ❑ Denied <br /> Reviewer: �-����Z.. � Date: — ( r�3'- � `� <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 />