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, <br /> *'� ATTENTION APPLICANT ** '�°` <br /> , . .. : <br /> ___ Fill in all `appropriate blanks and check all appropriate boxes, <br /> I wili be installing the foilowing: <br /> Tank <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: ��SO I, b(�O �S� <br /> Treatment System <br /> Trenches s.f. <br /> � Mound Co 3� s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> Final Cover/ Top Soil <br /> to 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 Minnesota and certifies that all statements made on this <br /> application are complete, true and correct. <br /> Signature of Applicant `— � G-� ��, � , Date: � �� <br /> MPCA License No.: (��,� I � <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: �/' � Date: ��-� - �-d� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic System Permit Application.doc <br /> 2 � 2 <br />