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SBPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) ` <br /> New Construction, Full System $75.00. . . . . . . . . . . . . . . . . , <br /> Replace Existing System (1 or more new tanks & drainfield) $50. 00. . . <br /> Partial Replacement (replace just tanks or just drainfield) $30. 00. . . <br /> $0.50 State surcharge added to above �ermit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMLNT WITH THIS APPLICATION <br /> ******�**t*********�****************#*******:******�*******�**�********#*** <br /> NOTB: App licant must initial all spaces. Fil 1 in all appropriate blanks, <br /> check all appropriate boxes. <br /> In' <br /> 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: �- , <br /> A. Tanks: �Precast Concrete Other Manufacturer_L� <br /> Tank Capacities: 1) I� G' gal. 2 ) 01 �D gal. 3 ) gal. <br /> B. Pump Station (if requir d) <br /> Pump make & model �rl� (attach pump curve & <br /> literature) ; system design requires gpm at feet <br /> of head. High water alarm make & model . <br /> Outside electrical work to be completed by _installer <br /> electrician other . Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> � Trenches: �O s.f. Mound <br /> Dept�r" of rock below pipe �" Rock bed dimensions 'x ' <br /> ✓ Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borrowed from site ' <br /> (show location on site plan) <br /> trucked in <br /> ***�*��****�**��:::**:*�**:#**:�*�:***:*�******:���***�:�***�**�*�*��::**** <br /> The undersigned hereby applies to the City of Orono for issuance of a <br /> septic system installation permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application <br /> are comp lete, true and correct. <br /> Signature of Applicant: Date: .S l `� <br /> MPCA Certification No. : �'`�� <br />