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_ , . <br /> � �� _ . . , , . . • . ' . <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. � <br /> 1. I have received a copy of the system desi�n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin�Q e followin�: �,i�' <br /> C�'� <br /> A. Tanks: 1/precast Concre[e Nn Other 'Manufacturer �''���-�S <br /> Tank Capacities: 1) �2So gal. 2) op gal. 3) ��Sa gal. <br /> B. Pump Station (if required) <br /> Pump make & model �,��� S -�Po 5 (attach pump curve & <br /> literature); system desi�n requires O gpm at <br /> �_ _�1 S feet of head. <br /> High water alarm make & model /�,,.�(.�o„e,. S�:�.:f�� Outside <br /> � ' electrical work to be completed by installer electrician � <br /> ocher . Inside electrical work must be completed by <br /> electrician. <br /> C• tment S tem: <br /> re es: s.f. �� �/��SSv rC� B� <br /> Depth o k below pipe " Rock bed dimensions x ' <br /> rop xes Sand bed dimensions �x ' <br /> istribution Box Pressure Dist. Pipe Diam. ��, <br /> Maniford Pipe Diam. a " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> �how location on site plan) <br /> trucked in <br /> The undersi?ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regutations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant: � Date: � a, C� 7 <br /> MPCA Certification No.: � S <br /> Staff Review: Approval Denial <br /> � � Revietiver: Date: �` �� '�� <br /> Reason for Denial• <br />