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� . <br /> '"i` ATTENTtON APPLICANT� <br /> filt in atl a ra riate bianks and check all ap ro riate boxes. <br /> i wiii be instaliing the foflowing: <br /> T n ks <br /> �] Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 2 <br /> Size ofTanks: 2250 1300 <br /> Treatment System <br /> Trenches s.f. <br /> � � <br /> Mound 10 X 6 3 s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> NOTE: The contractor is required to provide an As-Buiit of the system before the <br /> finat 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 l d���_'c�_ ��,��,�,�,m,�,,; Date: 9�26/2011 <br /> MPCA License No.: / (� � <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: lil ✓��.� Date: I ��/ , <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): _ �� � S N2.e� T� �Q <br /> —� J�; �� � � f3QFp,('e �,�,5�f-A r r �-�--�d�I U � <br /> �l� /�c� �n..� , <br /> Reset <br /> W:1(Permits)tSep6c Permit Application-Updated Surcharge 7-f-10.doc <br /> 2 �2 <br />