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! <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> bs�xes. � <br /> � <br /> �'� '�' 1. I have received a copy of the system design including the City of Orono <br /> Sep[ic System Approval Cover Sheet. <br /> , 1�� : <br /> 2. I will be installing the following: 1 <br /> A. Tanks: .- � Precast Concrete Other Manufacturer _! �•�.� ,=� ��' <br /> Tank Capacities: 1) �;r'^� gal. 2) `��!� gal. 3) � ``•� gal. <br /> B. Pump Station (if required) <br /> Pump make & model �'��, _ , ��� �;�,J�':���_,�� —�� (attach pump curve & <br /> literature); system design requires �3 gpm at ( � feet of head. <br /> High water alarm make & model �_�� � �<. c,�-- 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. / '�����Mound ; __� —�/ , <br /> Depth of rock below pipe " Rock bed dimensions ' r<> 'x ?��_ <br /> Drop Boxes Sand bed dimensions ��,,; 'x �� ' <br /> Distribution Box Pressure Dist. Pipe Diam. i '�z- " <br /> Maniford Pipe Diam. �— " <br /> D. Final Cover/Topsoil to be: j���orrowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, a�rees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> SianatureofA licant: ' � � �ai Date: �. -� �% �-� <br /> � PP ��' 1 �-- <br /> MPCA Certification No.: � `� �{ <br /> Staff Review: Appro, al Denial <br /> , <br /> �/ /a��qZ� <br /> Revie�ver: �� �i1 .,"� � Date: <br /> Reason for Denial: <br />