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c-�t <br /> I will be installing the following: <br /> Tanks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: � �7^a� � V�V <br /> Treatment System <br /> Trenches s.f. <br /> � Mound s.f. <br /> ��d�� <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 /> � � l <br /> Signature of Applicant Date: �� /� <br /> MPCA License No.: �� �!^� <br /> Staff Review: � Accept ❑ Denied <br /> Reviewer: /vW �'�/� Date: � 1 b — 1 l <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> i�-1000 ,ll'A-I/v�1 5 ep-I'-,c i�9� KS � �' �'rA�!3A 3� <br /> � % � Po SA I � �/ ,q cCr S Q ���"c �l�.� ���'S� �El S <br /> � tos� � ,� �.� �s a�ss,.-�� c . <br /> W:\(Permits)\Septic Permit Appliqtion-Updated Surcharge 07-28-11.doc <br /> 2 � 2 <br />