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I will be installing the following: <br /> Tanks <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: JG N` & /I'i .1/i c3 L/l.T — 7n pe- 1141.6 1/uuiDT <br /> /SRti/L- rib1LL <br /> Size of Tanks: <br /> Treatment System <br /> Trenches s.f. <br /> x Mound 41x81 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, nd correct. <br /> Signature of Applica Date: 8/2/10 <br /> MPCA License No.: 1888 <br /> Staff Review: DA-Accept ❑ Denied <br /> Reviewer: ( .�-�(, ;YDate: � " S� 10 <br /> Reason for Denial: <br /> Comments (to be printed oninspection card): <br /> SeA rs-c-i �I s Per- Des, c-^-1 <br /> Reset Form <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 / 2 <br />