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, Jul 17, 2015 0237PM HP FaxKlingbergs 9524473982 page 2 <br /> *'�qTT�NTtQN APPLi�Afi11'�** = <br /> �� � ; � , � ,r , y ,�.` <br /> F�il irt ail a r�a ri�t� bta�ks ar� Gh�ck a�lt a riat+�boxes. �, ...� f <br /> - �:o�,:_.. <br /> I will be installing the following: <br /> Tanks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: �I�( C�- <br /> — Size of Tanks: Sn ��� � �� ���� <br /> Treatment System <br /> Trenches s,f. <br /> � � <br /> Mound C� C �s.f, �OC(� ��� (Q)C(p a�5 � <br /> Gravel less s.f. <br /> Chamber s.f, <br /> NOTE: The contractor is required to provide an As-�uilt of the system before the <br /> final inspeciian. <br /> The undersigned hereby applies t� 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 ali statements made on this <br /> application are complete, true. nd correct. <br /> /��?' �� �,' � � <br /> Signature of Applicant� . Date: /«1�a�S� <br /> MPCA License No.: � ( <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: � <br /> Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card}; <br /> 2 / 2 <br />