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.� <br />, _. ._ . _ . � � . , � <br /> , . <br /> � . <br /> " ? 4 <br /> r. _� <br /> . ,� ".�. t . ..� ,.4 -� <br /> � . . . . . . � _. <br /> .. . - < . � ,.4.. <br />': ,� ...Y , . . e',... � -" 3 ; , W.,v,. . . KiF. <br /> I will be installing the following: <br /> Tanks <br /> ,� Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: �� <br /> Size of Tanks: i��� ��ic6o l��o f°� <br /> Treatment System <br /> Trenches s.f. <br /> ! <br /> i/� Mound ��v 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 correct. <br /> Signature of Applicant��a�� � 2 Date: �—�a � �� <br /> MPCA License No.: �6� <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: Date: (-� r � � -- � � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 5p� t S ?o � �- C�C1�� �'/e � � T �� r� <br /> �� S�Pc�� <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />