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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: �-� <br /> Size of Tanks: ,��'��i� �� /��o�� l �' G,,� � �c��� <br /> a baC <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 Applicant�� �c�:�,,... /�� ��c�e-��„�� Date: 7 �� --������ <br /> MPCA License No.: 7� �� <br /> Staff Review: �Accept ❑ Denied <br /> Reviewer: �( ,c ,��I.,L, ��� Date: �� �S �,,�U � C; <br /> Reason for Denial: <br /> � <br /> Comments (to be printed on inspection card): � x•- S t-- iJc.� ;1i.� ,� <br /> �1✓���< �—Z:� � W /-� �--�' .�I_ � `� .T /�� �� <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 � 2 <br />