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� , ,, <br /> . � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> l. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> v 2. I will be installin� the following: <br /> r <br /> A. Tanks: Precast Concrete Other Manufacturer L��� S <br /> Tank Capacities: 1) ���c-c� gal• 2) ��;o<; gal. 3)/�c-�> gal. <br /> B. Pump Station (if required) , <br /> Pump make & model //�ily��s �/y'�' `�t (attach pump curve & <br /> t`r`� r � / � + Q m at 'Z c.% feet of head. <br /> l� A � irPl• cvctPm desiQn requ' es "r(�. �U <br /> Hiah �rater alarm make & model ,��{/a�� �.,�,�-.i�%"� • Outside <br /> electrical work to be completed by installer �electrician <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: ` / <br /> Trenches: s.f. v Mound <br /> Depth of rock below pipe " Rock bed dimensions �'x 5_�' <br /> Drop Boxes Sand bed d'unensions �'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. '� " <br /> Maniford Pipe Diam. "?- " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> � trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> re�ulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant: /�_--�� �% � �" Date: y �t' j� <br /> �� <br /> MPCA Certification No.: �j� � 5��� ��� <br /> Staff Review: Appr Denial <br /> Reviewer: SL� c/ Date: �� <br /> Reason for Denial: <br />