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I will be installing the following: <br /> Tanks <br /> j�Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: <br /> Size of Tanks: ��� <br /> Treatment System <br /> Trenches s.f. <br /> � Mound 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 /> 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 Applica � Date: ,/�� -� / � <br /> MPCA License No.: �7� <br /> T <br /> ♦ t l <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: .%� Date: 1 ot—7— t 0 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> � <br /> W:\(Permits)�Septic Permlt Application-Updated Surcharge 7-1-10.doc <br /> 2�2 <br />