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, <br /> � <br /> .:� � �� -.�,�; x .. �. . , ._ _ _. ,. an,. ` " <br /> . : �,.. <br /> � . � .>.. , ;: � ,,.� , � <br /> .. . ; � � . . <br /> . <br /> , <br /> ; � <br /> � �� . . ������:� <br /> . ,� ,, �. , <br /> . <br /> ' < <br /> , <br /> ^.�nf . �- .�� �����, ��� , . : � t..,. � �- . m�,:. ,��,.� : �_�� �,. ,� �� t�,s, . �-a��,.�: <br /> ��_. � v�_�.. � r . <br /> I will be installing the following: <br /> T ks <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: C�� ��(� ( � ' `� _ <br /> Treatment System <br /> Trenches s.f. <br /> � Mound r � 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 /> �nal 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 a d correct. <br /> Signature of Applicant R�M� �Date: � ( ����' � � <br /> MPCA License No.: � � � � <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: /� �(� ��1:� �ate: � �— l8 13 <br /> ��� � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> '� I� � S�ct�a-r c -T-o►.� r-b A S G �as c H s �bs �t�� <br /> rz� {���S�e — C �F-�c- -y-��. � ��' f3A�e <br /> �F �-� . � � � Q y /��•�° _ <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />