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� ,.+�1 <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 charges that may be incurred by the City � <br /> because of my failure to comply with the provisions of this Ordinance. <br /> ' � � 3 pl �' � — 1 " —O'z__ <br /> Signature of Designer MPCA License# Date <br /> ��J���'8. S c.����vr��:�-; �S� w�-C��.�:� Lp.� '7 t�: ��?�� - 3 Sf��, <br /> Printed Name Address Phone Number <br /> �S•Y�t LN��� N►� <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 responsibil�ty to mai.�tain an annual operating pernut in acc�rdance with <br /> Orono Ordinance No. 199 and MN Rules Chapter 7080. Orono ISTS Permits aze not <br /> transferable and an subsequent owners must apply for a new operating permit with Orono. <br /> �" / <br /> P/Lt.c-�—� t' �l..Cn.r(Q �,G�r�Qs � �-� /L3 2 <br /> Signature of Owner Printed name Date <br /> �� ,� a�,,,.� 6'-z�-d z. �.- 7�s {�;-�r-- <br /> Application reviewed by Date Approved or Denied MPCA Reg. # <br /> � <br />