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- �. <br /> '** ATTENTION APPLICANT� ,. - <br /> Fill in all a ro ria#e blanks and check a!! a ro ria�e boxes. ' <br /> I will be instaliing the following: <br /> Tanks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 3 <br /> Size of Tanks: t SotS 1 5� 1 S� <br /> � ��.p'��c_ `C'#�t��� ��os�r{�-- 'rf�c�t� <br /> Treatment System ' <br /> Trenches s.f. <br /> .• �_ Mound �l� ro�a s.f. 1��. �, y� ��.3 <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 correct. <br /> Y�Y�--E 1�� �v� y- �A tZ'C't-��.R`s r �r�c. �E t��C�l��.. �o n'T'R Ar c.-rt�ft <br /> Signature of Applicant �.�, Date: ti O / ��/2,a�z. <br /> H-l��t�-S �- 5 a N S �Y.'�.A�v f4T�� �, 's cr�.. �. � � {��M \�T <br /> MPCA License No.: � ��a <br /> �-P�P�--1 ��n�' <br /> Staff Review: � cept . ❑ Denied <br /> Reviewer: � Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />