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** 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 /> Ta n ks <br /> �X Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 2 <br /> Size of Tanks: 1250 1000 1000 Pump <br /> Treatment System <br /> Trenches s.f. <br /> X Mound 4147.4 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 /> finaf 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 /> � ���.�,_. �' � � � <br /> Signature of Applicant �' �� � �= Date: <br /> MPCA License No.: ��y� <br /> Staff Review: � cept ❑ Denied <br /> Reviewer: Date: � <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 /2 <br />