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� � ** ATTENTION APPLICANT ** <br /> ; <br /> Fili 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 �� <br /> Treatment System <br /> Trenches s.f. <br /> �� Mound � 3 z � s.f. j c��l 6 3 ' rf?��� I� f�,� � . <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 /> i <br /> . �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�� ( 2"-� Date: Z� � G� <br /> MPCA License No.: �� � <br /> / <br /> Staff Review: O�Accept ❑ Denied <br /> Reviewer: ����� � Date: — l `��3'� U `� <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 />