Laserfiche WebLink
** ATTENTION APPLICANT ** F <br /> Fill in all appropriate blanks and check all appropriate boxes. <br /> I will be installing the following: <br /> T <br /> Precast Concrete 111 Fiberglass 111 Plastic El Other <br /> (list manufacturer) <br /> Number of Tanks: 2- <br /> v✓ s r re - '-' �x�Citi r•3 A <br /> Size of Tanks: &2D/ /000 /, Doo /, F4- <br /> Treatment System <br /> Trenches s.f. <br /> Mound 370 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. tr .e and correct. <br /> Signature of Applicant Date: Z ' /c2 <br /> MPCA License No.: C �2 /4 Ye) <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: ,4Aydi.f ,c icsa Date: q� 3O -1 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 / 2 <br />