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. . <br /> � <br /> ** 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 /> Number of Tanks: ti <br /> CxlS�lhq <br /> SizeofTanks: �D00 �V00 Z• IDOD`� <br /> Treatment System <br /> Trenches s.f. <br /> 1 Mound (C�r�S s.f. �•✓� �b����Z.S� <br /> S1�J� ��,(�� X ��} <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 ��f��� /.i� Date: � 7 10 <br /> MPCA License No.: ��73 19�� <br /> � <br /> Staff Review: � Accept ❑ Denied <br /> Reviewer: /�d� r�� Date: 7- f 3- i O <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> Reset Form <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 � 2 <br />