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'� <br /> �' f <br /> >EPTIC SYSTEM PERMIT APPLICATON — PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $100. 00 . . . . . . . . . . . . . . <br /> � Repair or Replace Existing System $50.00. . . . . . . . . . . . . <br /> 0.50 State surcharc�e added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES � <br /> DO NOT MAIL PAYi�NT WITH THIS APPLICATION <br /> �*�*******�#******�********�**��*�***�*********�*�***#**************##***** <br /> `�OTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. , <br /> I itial <br /> l. 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 X Other Manufa�cturer <br /> -'T <br /> Tank Capacities : 1) ��_gal. 2 ) �_gal. 3 ) i Q��al. <br /> B. Pump Station (if required) <br /> Pump make & model 1��� _ _, (attach pump curve & <br /> literature) ; system design requ res �gpm at � feet <br /> of head. High water alarm make & model � <br /> �utside electrical work to be completed by _installer <br /> electrician _other . Inside electrical work <br /> must be completed by electrician. <br /> C. Tr tment System: <br /> en che s• s.f. Mound <br /> Depth o c• below pipe " Rock bed dimensions %1� `x�' <br /> op xes - Sand bed dimensions�'x 3 S�'" <br /> Distribu ' n 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 /> ********�*�*#******tt*tt�*�*�*#*�t*****t#**#*******t**tt�*t**�***�**:**���* <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 comp 1 ete, true and corre ct. � <br /> Signature of Appiicant: � _Date: � �/ /� <br /> :dPCA Certification No. : � � <br />