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.. <br /> . __ . _ __ ._ ._ _� . <br /> . <br /> SBPTIC SYSTEM PERMIT APPLIGATON - PAGE 2 ' <br /> � <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 permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> t*****�***#**�********�********t*************�****#****�***t**�**�*t***�*** <br /> NOTS: Applicant must initial all spaces. Fil I in al 1 appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> l. I have received a copy of the system design including the <br /> City of Orono Septic System A�proval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: e/� Precast Concrete '� Other Manufacturer <br /> /���� ,,,� ;�„� <br /> Tank Capaciti�s: 1 )������gal. 2 ) ���al. 3 ) gal. <br /> , � <br /> B. Pump Station (if required) <br /> Pump make & model (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: �j���� ���: �/'d'�� ���� � <br /> � Trenches: �� s.f. Mound <br /> De th of rock��elow 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: �C borrowed from site <br /> (show location on site plan) ' <br /> trucked in = <br /> ; <br /> **:**�**********�**�*�*�*t***�*********�****���****�**#�:t*�****:�******t** � <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 r <br /> of Minnesota, and certifies that al 1 statements made on this app lication +. <br /> are comp lete,. true and correct. � <br /> Si nature of A licant: � � � Date: � �' � " ` � ` <br /> g &P <br /> MPCA Certification No. : �_�t/�, <br /> �, � � � � ; <br /> ��� �����/�dl =`� <br /> ���� � <br /> �� � <br />