Laserfiche WebLink
i <br /> . � � <br /> ** ATTENTION APPLICANT ** <br /> Fill 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 /> � <br /> Number of Tanks: __� <br /> Size of Tanks: -� ( �S� � ��C� <br /> Treatment System <br /> Trenches s.f. <br /> v Mound o�� �� � s.f. <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 /> 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 corr t. <br /> Signature of Applicant e1���'�����`-�-�' Date: � ! �S /� � <br /> MPCA License No.: ��- J S <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: ���� �(, �`� �� �� � � <br /> , Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 � 2 <br />