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"^za' t �". `• e mom- -i -. <br /> c <br /> i iii a •ro:•ria e b'alike and c ec -el °a.'ro nate •ox ' <br /> I will be installing the following: <br /> Tanks <br /> A'Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other 04 <br /> (list manufacturer) <br /> Number of Tanks: 3 <br /> Size of Tanks: (6900 ( OO /030 <br /> Treatment System <br /> Trenches s.f. <br /> Mound 3„?'6) 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 a carr ct. <br /> Signature of Applicant Date: 6 -- <br /> MPCA License No.: <br /> Staff Review: Accept n Denied <br /> Reviewer: /tiJ4 )2,0L.4 Date: 17- td <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 />