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1:ATTENTIONAP C N <br /> a r pix <br /> � 0 P Y� <br /> %.; , 111 1 . _ , •�rop.r a e;-•1 stain• C ep say p• •® • ® � , <br /> I will be installing the following: <br /> Tanks <br /> 1 Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Numbef r of Tanks: / <br /> Size of Tanks: /'Soo y��(e oP� "'t^t /G a(5,„ <br /> l /►'� t,`-}, - ��o <br /> Treatment System <br /> Trenches s.f. �e r qe, 17)1c2 ce ST/) <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 hreby 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 trie State of Minnesota and certifies that all statements made on this <br /> application are comp ete, true and correct. <br /> Signature of Applicarllt Date: 1., ,62 <br /> MPCA License No.: � 19 <br /> Staff,Review: ❑ Accept , ❑ enied <br /> Reviewer: I ' _ Date: (1--15--/f <br /> �/ f <br /> Reason for Denial: <br /> Comments (to be prfinted on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 07-28-11.doc <br /> 2 / 2 <br />