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SBPTIC SYSTEM P$RMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $75.00. . . . . . . . . . . . . . . . . <br /> Replace Existing System (I or more new tanks & drainfield) $50. 00. . . <br /> Partial Replacement (replace just tanks or just drainfield) $30. 00. . . <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYr�NT WITH THIS APPLICATION <br /> #**:*****t�f****************�************************�****tt*�**�********** <br /> NOT$: Applicant must initial all spaces. Fil 1 in al 1 appropriate blanks, <br /> check all appro�riate boxes. <br /> Initial <br /> �� 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> � ����—%''������c�:2 u-� ��.. <br /> 2. I will b installing the following: � <br /> A. Tanks: �Precast Concrete Other Manufacturer <br /> Tank Capacities: 1 ) gal. 2 ) gal. 3 ) gal. <br /> B. Pump Statian (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: <br /> Trenches : s.f. Mound <br /> Depth 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 /> **ititdt*�t�tit�**tit�t**it�*itdt***�tdt**tt*dtitit*dt�tit*it****�tff**it*********#ititittdtits***ttf* , <br /> k <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 al 1 statements made on this app lication � <br /> are comp lete,. true and correct. <br /> % - <br /> Signature of AFplicant: �..�'� ��� _____ � Date: �� /C� �� <br /> MPCA Certification No. :� <br />