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r.. - <br /> �* ATTENTION APPL#CANT** <br /> Fill in ali a ro riate blanks and check all a ro riate boxes, <br /> I will be installing the following: <br /> T ks <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> / � (list manufacturer) <br /> �\ �Number of Tanks: <br /> ? , <br /> Size of Tanks: Z� � <br /> Treatment System <br /> Trenches s.f. <br /> � Mound � �C� <br /> 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 corre t. � <br /> _----- <br /> Signature of Applicant ' Date: ��� � � �� <br /> MPCA License No.: C--- � � � <br /> � <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: ` Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />