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i�. � <br /> ** ATTENTION APPLICANT ** � ' I <br /> ; Fill in all appropriate blanks and check all appropriate boxes. � <br /> I will be installing the following: <br /> Tanks <br /> ❑ Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> � (list manufacturer) <br /> % <br /> Number of Tanks: I � <br /> , �- <br /> , <br /> Size of Tanks: ? �i � f� j li�� v % � J <br /> Treatment System <br /> Trenches s.f. <br /> � ��'�- / o�.� t3P� <br /> �% ��3 0 � <br /> Mound !� s.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 /> 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 Minnesofa'and certifies that all statements made on this <br /> application are complete, true and correct. ' <br /> , � __... f <br /> SignatureofApplicant ;,��� ' �% ��-� Date: -< �� � <br /> --� �: <br /> �r �" _- , c>� <br /> MPCA License No.: � <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: �',, ���,� �'� Date: �v�� ( -O � <br /> - - - r <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 />