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SEPTIC SYSTEM PERIKIT APPLICATON - PAGE 2 <br /> •' Y <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 />�P�tij�1 �Replacement (replace just tanks or just drainfield) $30.00. . . <br /> f��,�./ -Cfit/L - <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAY1r1ENT WITH THIS APPLICATION <br /> **********�************�***�*****:*****�*�***********�***�*************���� <br /> NOT$: App licant must initial all spaces. Fill in al 1 appropriate blanks, <br /> check all appropriate 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 /> � 2. I will be installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal. 3) gal. <br /> � B. Pump Station (if required) <br /> � � �� Pump make & model �[5 (attach pump curve & <br /> literature) ; system design requires gp at feet <br /> of head. High water alarm make & model �jS <br /> Outside electrical work t be completed by _installer <br /> \ electrician other . Inside electrical work <br /> must be completed by electrician. <br /> � <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 /> :**�*:******:��:*�*****�**�:���**s***#***:�**#********�*��****���***�*****: <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 app lication <br /> are complete, true and correct. <br /> Signature of Applicant: Date: <br /> MPCA Certification No. : ���� <br />