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Notification: <br /> I hereby certify with my signature, as the Designer, that all data for the operating permit <br /> application is true and correct the best of my knowledge. I agree to indemnify and save City of <br /> Orono harmless from all losses, damages, costs and charges that may be incurred by the City <br /> because of my failure to comply with the provisions of this Ordinance. <br /> Signature of Designer MPCA License # Date <br /> SrS 1 SL►a-yX51 1 4+,o s-itt a t-14,93 5toce, <br /> Printed Name Address Phone Number <br /> ST• v� t.t.AA r-ft... ✓N g5-376 <br /> I hereby certify with my signature, as the owner of the property where this system is to be <br /> installed, that it is my responsibility to maintain an annual operating permit in accordance with <br /> Orono Ordinance No. 199 and MN Rules Chapter 7080. Orono ISTS Permits are not <br /> transferable and any subsequent owners must apply for new operating permit with Orono. <br /> i, ,� .r . r(tr-dyl l(OZl osk <br /> Signatur-/•f 0 - Printed name Date <br /> aVZ.ffs.e.".. 9 -Irk_t;Z C: —1 InS9ec►-,,,r <br /> Application reviewed by Date Approved or Denied MPCA Reg. # <br />