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� . <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appiopriate <br /> boxes. <br /> �/ 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I�vill be installing the following: <br /> A Tanks: �_Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) N�Sv gal. 2) !25� gal 3) /Dc>d Qal yJ io�g� <br /> B. Pump Station(if requued) <br /> Pump make&model_ f�`( ✓''�C Dav� 1� (attach pump curve& <br /> literature); system design requires �g�at % v feet of head. <br /> Hi;h water alarm make&model —��`�"p . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> 1�Ianifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Qrono for issuance of a septic system installation permit, <br /> agrees to do all work in strict accordance with ordinance�of the City and the re�ulations of the State <br /> of iVlinnesota,and certifies that all statement ade on this applica ion are complete,true and correct. <br /> Si�natureofApplican Date: �� ^ �— � r <br /> NIPCA License No._ � �� � <br /> . . . . . <br /> StaffReview: Approval Denial <br /> Reviewer: Date• <br /> Reason for DeniaL• - <br />