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� - � 1 <br /> '°*ATTE�dTiON�►PPL{CANT** <br /> Fif! in alt ro iate blanks and check all a ro rfate boxes. <br /> I will be installPng the fiollowing: <br /> T ks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other � <br /> i anu� ) <br /> Number of Tanks: �',t'i�� �� <br /> Size of Tanks: �""- <br /> Treatment SysEem <br /> Tre�nc�i�es s.f. <br /> A[ _r• 1_�� �� !0 s.f. <br /> �L�, pdenr� <br /> Gravel less s.f. <br /> Chamber s.f. <br /> NOTE: The contractor is required to provide an As-Built af 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 #o do ail the work in strict accordance with ordinances of the City <br /> and regulations of the State of Minnesota and certifies that ail statemen#s made on this <br /> application are complete, true and corr <br /> Signature of Applicant Date: 7 `��� /.3 <br /> MPCA License No.: c�/ 9 <br /> 5taff Review: �,,Accept ❑ Denied <br /> Reviewer: ��iL�� Date• / V���^-J _ 1 <br /> � <br /> Reason for�eniat: <br /> Gomrnents �t4 be pri�ted on inspection card): � (� + ��, ��.(�i � <br /> -----� e l I 0 �' : ��� ,� T- v�-�. �i�.� o� <br /> � rG` O� T'b <br /> W:1{.lpplications,License or Permlt Appficstans)lPertnitslSepNc Perm�l Application-Updated Surcharg�07-28-19.doc <br /> 2�Z <br /> £'d L 6ZL-ZL6-£9L 'o�uosae;ed'f aawl3 d 61�Z0£6 9Z d8S <br />