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f <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <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 will be insta.11inj the followin�: /' , <br /> A. Tanks: � Precast Concrete Other Manufacturer �Ir� lUr''�e— <br /> Tank Capacities: 1)�jal. 2) �al 3) [�� jal <br /> B. Pump Station(if required) <br /> Pump make& model 7Q����P/' '� �� (attach pump curve 8c <br /> literature); system design requires .��'. ,�gpm at / 7. �t feet of head. <br /> Hi�h water alarm make& model . Outside <br /> electrical work to be completed by installer�_electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. � Nlound <br /> Depth of rock below pipe " Rock bed dimensions�' x �7�' <br /> Drop Boxes Sand bed dimensions�' x 7�j ' <br /> Distribution Box Pressure Dist. Pipe Diam. �— " <br /> Manifold Pipe Diam. a-- ° <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 permit, <br /> ajrees to do all work in strict accordance with ordinances of the Gity and the regulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> �-- <br /> SignatureofApplicant i��� Date: �o`-'�7�' d� <br /> MPCA License No. ���� � � <br /> 7�Z� I''1 �C � � <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staf�'Revie�v: �°,pproval Deniai <br /> �t�vaetive�-: ���.I.LJIG ".-'<J��i"�� I)ate• �v ' Z `t �d � <br /> Reason foa� �eniai: <br />