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in - a• •ro-•nae • an' san• checkall'" <br /> a• •ro•ri ate box_. ;�...W.... <br /> I will be installing the following: <br /> Tan <br /> Fl Precast Concrete n Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: <br /> Size of Tanks: /Ow jdw lGb� <br /> Treatment System <br /> Trenches s.f. <br /> Mound 5 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 /> • <br /> Signature of Applicant I . •45 Date: //--( <br /> MPCA License No.: c0 e) <br /> Staff Review: ccept ❑ Denied <br /> Reviewer: cam( Date: / 1-20 -0 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 />