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hOiC <br /> '.21W10041430' <br /> s100E y t : k 4, � k b E.:. <br /> I will be installing the following: <br /> Tanks <br /> Precast Concrete ❑ Fiberglass 0 Plastic 0 Other <br /> (list manufacturer) <br /> Number of Tanks: ;L <br /> Size of Tanks: 72.260 119eV <br /> Treatment System <br /> Trenches s.f. <br /> Mound - 75b0 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 correct. <br /> Signature of Applicant G7G:,���, Z Date: 7 - 18 -�o�G <br /> MPCA License No.: 76. <br /> 76 f <br /> Staff Review: ) Ac pt o?:and <br /> Reviewer: �1 Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 / 2 <br />