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1 � <br /> I will be installing the following: <br /> Tanks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> Qist manufacturer) <br /> Number of Tanks: / <br /> Size of Tanks: O o' <br /> Treatment System <br /> Trenches ��.� }� � <br /> . T <br /> � Mound s.f.��� jZp Gi� ��� S <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 ordinanc�s 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 i�� ���^ Date: � �1S "' 1 f <br /> MPCA License No.: ��I^� <br /> StafF Review: � Accept ❑ Denied <br /> Reviewer: t��vL�t'.Y�C.� �� Date: � � � O ' � ( <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> ��/�cQ SQP-� c �A�� �S c �as� To Ha� S e <br /> A S poSS, Z� f Q <br /> � C�- / OOd �A !!a ti1 �"/=)� K. i F �Qe�e cl �c�� �o ( <br /> W:\(Permits)\Septic Permit Appliqtion-Updated Surcharge 07-2&11.doc � /� <br /> 2 � 2 �r � <br />