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'"'k ATTENTION APPLlCANT'�* <br /> FiH in a!1 a ro riate bl�nks and check all a ro riate boxes. <br /> I will be installing the following: <br /> T ks <br /> ,� Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturerj <br /> Number of Tanks: � <br /> Size of Tanks: �,,3dp <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 rre <br /> Signature of Applicant � <br /> Date: ��� <br /> MPCA License No.: n�19 <br /> Staff Review: cept ❑ Denied <br /> Reviewer: . Date• <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2/2 <br />