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�� <br /> � ! <br /> NOTE: Applicant rriust initial all spaces. Fill i.n all appropriate blanks, check all appropriate <br /> boxes. - <br /> 1. I have received a copy of the system desi?n includin� the Ciry of Oro�o / . <br /> Septic System Approval Cover Sheet. �� <br /> �-h� 1lhe���rr, cr� c�"�� �-�� <br /> 2. I � 'il be installing the followin�: Scru��.� L�� �,�,� Co.rP �r l�� <br /> A• Precast Concrete Other Manufac er <br /> Tank acities: 1) gaI. 2) Qal. , <br /> � ) gal. <br /> B• Pump Station 'f required) <br /> Pump make & del . (attach pump curve & <br /> literature); system i;n requires opm at feet of head. <br /> , Hi�h water alarm ma & el Outside <br /> • electrical work to be comp d by installer electrician <br /> other nsi electrical work must be completed by <br /> electrician. <br /> C. Treatme ystem: <br /> renches: s.f. Mound <br /> pth of rock below pipe " Rock b dimensions 'x ' <br /> Drop Boxes Sand bed ' ensions 'x ' <br /> Distribution Box Pressure Dis Pipe Diam. " <br /> Maniford Pipe iam. " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site an) � <br /> trucked in <br /> The undersi�ned hereby applies to the City 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 tha[ all statements made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant: ��-'��c'-�--- Date: 5�Ir-/�'� <br /> MPCA Certification No.: ' ~ �� o�� �. <br /> Staff Review: Approval Deni <br /> � Revietiver: Date: �"��� <br /> Reason for Denial: <br />