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I will be installing the following: <br /> Tan <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: <br /> Size of Tanks: l 3 0U t 3 0c) l 3 0 C) <br /> Treatment System <br /> Trenches s.f. <br /> Mound S©O s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> Final Cover/ Top Soil <br /> to be borrowed from site (show location on site plan) <br /> ?(. trucked in . <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 ate: of <br /> MPCA License No.: C9 FC) <br /> Staff Review: 'Accept ❑ Denied <br /> Reviewer: Date: //''l 70 7 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc <br /> 2 /2 <br />