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�� � � <br /> � � • ' � <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 chazges that may be incurred by the City � <br /> because of my failure to comply with the provisions of this Ordinance. <br />� L L�--- , � 3�1 �' �o — i '7 -�-0"x--- <br /> Signature of Designer MPCA License# Date <br /> ��7��-�'�. S�t���v�ti�.-�,�> �S� u-�--C��v�c::;: L�.� '7 t�: -�1�� - 3 S1�b <br /> Printed Name Address Phone Number <br /> �S•Y►�i l..N�1�. r��..; <br /> " 5�3�� <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. Orono ISTS Permits are not <br /> transferable and an subsequent owners must apply for a new operating pernut with Orono. <br /> �C n -� <br /> E'u.c.�—� �t'C�G..r(X ��l��QS � a-� /z'Z <br /> _ , <br /> Signature of Owner Printed name Date <br /> �� •��L�ir•� �'Z.7�d Z �.� �S tc ivr" <br /> Application reviewed by Date Approved or Denied MPCA Reg. # <br /> � <br />