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'L. <br /> 5 <br /> M <br /> 1 will be installing the following: <br /> Tanks <br /> � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: � <br /> Size of Tanks: 6C� � <br /> Treatment System <br /> Trenches s.f. <br /> � Mound I� �-��- ' 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 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, t and rrect <br /> Signature of Applicant Date: 1 � � �� ��� <br /> MPCA License No.: � ��� <br /> Staff Review: ,�Accept ❑ Denied <br /> Reviewer: ���� �� Date: �— ��' �� <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Pertnit Application-Updated Surcharge 07-2&11.doc <br /> 2 � 2 <br />