Laserfiche WebLink
** ATTENTION APPLICANT ** <br /> Fill in all a ro riate blanks and check all a ro riate boxes. <br /> I will be installing the following: <br /> Tanks <br /> [� Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> � <br /> Number of Tanks: -� <br /> Size of Tanks: l�`�� ��4� 1�G G <br /> Treatment System <br /> �Trenches s.f. <br /> Mound � s.f. R's�'��' <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 �.���c�.�✓� /�,� Date: �u. 1 I .I�' <br /> MPCA License No.: ����� ' <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: �.1�� ( �/����KY �ate: �D" 7 !_�3 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): Se�f��G -trl4�.1�5 <br /> �l�t,�� t> (�t ��.�-F-� �t e� �- �- � {� O�F <br /> �-�'� ( l [ � l'��'f_ '"'f_�4� � �"� � l e lI i��h�2a/ll <br /> D � I���� � �S-h°�t-�� <br /> W:\(Applications,License or Permit Applications)\Permits\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />