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'✓ � <br /> ** ATTENTION APPLICANT ** � � <br /> Fill in ail ap�ropriate 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: <br /> Size of Tanks: Sa G��U ���� <br /> Treatment System <br /> Trenches s.f. ��. <br /> � <br /> � Mound �'�. � <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 /> instal�ation 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 re . <br /> -, <br /> Signature of Applicant :/' � ` �' Date: �� l=� <br /> MPCA License No.: �� �� <br /> Staff Review: Accept � ❑ Denied <br /> e <br /> Reviewer: % ' � Date: � � � ' �� <br /> � �.---� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />