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�� �� �!�c-t'� <br /> . _ _ INs(' _ -C�� ____i <br /> _ � � �� � <br /> SBPTIC SYSTEM P$RMIT APPI.ICATON PAGE 2 ,� <br /> � Permit <br /> Type & Fees (check one) , <br /> New Construction, Full System $75.00. . . . . . . . . . . . . . . . . <br /> Replace Existing System (1 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 PAYI��7T WITH THIS APPLICATION <br /> �*��***�**�t**t##**�*******��*************�***************:*#******�*****:* <br /> NOTB: Applicant must initial all spaces. Fill 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 /> � 2. I will �b�installing the following: <br /> A. Tanks: v Precast Concrete Other Manufacturer ��,{, ��,��r� <br /> Tank Capacities: 1 ) gal. 2 ) gal. 3 ) gal. �' <br /> ,� � <br /> B. Pump Station (if required) `�� �Y� ��c,vrvl�n1< �� �`-�U c='-�c-c�� � <br /> Pump make & model (attach pump curve & �@ �� <br /> literature) ; system design requires gpm at feet\' <br /> of head. High water alarm make & model . v��'' � <br /> Outside electrical work to be completed b y installer p <br /> _electrician _other . Inside electrical work .,t,�i\ �' <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. Z- " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> � (show location on site plan) <br /> ✓ trucked in <br /> ���:***********##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 al 1 statements made on this app lication <br /> are complete,. true and cor ect. <br /> �• <br /> Signature of A�plicant: ��I� w� . Date: � %C� <br /> MPCA Certification No. : <br /> i <br /> �"". � ,��� i <br /> � �./ � A � ��O <br /> � / �� 1 ; <br /> � : � <br /> � , � <br /> ; <br />