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i � <br /> Notification: <br /> I hereby certify with my signature, as the Designer, that all data for the operating permit <br /> application is true and correct the best of my knowledge. I agree to indemnify and save City of <br /> Orono harmless from all losses, damages, costs and charges that may be incurred by the City <br /> because of my failure to comply with the provisions of this Ordinance. <br /> Jl� �z �j,�c.�--=— _ 3�l `-� l l ' l� "°� <br /> Signature of Designer MPCA License # Date <br /> S;�Gt�� �•�i�l�l"�-v,'I�5 �/S l lG,�-�S��� Lra, N s'; �co3-�-�°t 7- 3�Iv� <br /> Printed Name SS, vHi�1.��- �N �S3��o Phone Number <br /> Address , <br /> I hereby certify with my signature, as the owner of the property where this system is to be <br /> installed, that it is my responsibility to maintain an annual operating permit in accordance with <br /> Orono Ordinance No. 199 and MN Rules Chapter 7080. It is the owners responsibility to inform <br /> new property owners of Operating Permit and Performance System. Operating Permits are non- <br /> transferable and all subsequent owners must apply for a new operating permit with Orono. <br /> ' ����a � A,r '�<i.,� k.6�';,l��' " �; i�, � � � • ��� , ,; � ' � . �� {� ,� ", <br /> � <br /> Signature of Owner Printed name Date <br /> /,� 1,�� n 7 f C <br /> i/�" + � -z.s--�, � '� 3 fi � <br /> Application reviewed by Date Approved or Denied MPCA Reg. # <br /> 4 <br />