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SEPTIC SYSTEM PERMIT APPLIC1�..a2R - PAGE 2 <br /> r � <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 PAYMENT WITH THIS APPLICATION <br /> �********************************�************************************�**:* <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appro�riate boxes. <br /> Initial <br /> � F. � l. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> � r� 2. I will be installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer ��>c;=�,•,��, <br /> Tank Capacities: 1 ) gal. 2 ) gal. 3 ) gal. <br /> B. Pump Station (if required) <br /> Pump make & model �x;s�,w.,�., (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 : s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensions �'x_SS' <br /> Drop Boxes Sand bed dimensions ��'x �S"' <br /> Distribution Box `'Pressure Dist. Pipe Diam. z " <br /> ,Manifold Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: � borrowed from site <br /> (show location on site plan) <br /> x� 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 complete, true and correct. <br /> Signature of Applicant: � z2 � h� Date: �j- /l-�7/ <br /> MPCA Certification No. : ��� <br />