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-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 surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMLNT WITH THIS APPLICATION <br /> p*�##*#*f#�****�***#*ie�***********#******�**�l'*�*�*�*�k***�****�*�**********!c <br /> �TOTE: Applicant must initial alI spaces. Fill in al.l appropriate blanks, <br /> check alI appropriate boxes. <br /> Initial <br /> _j�"� l. I have received a copy of the system design including tne <br /> City of Orono Septic System Approval Cover Sheet. <br /> I�o 2 . I will be installing the following: <br /> A. Tanks: �Precast Concrete �Other Manufacturer <br /> Tank Capacities : 1) ��o-���gal . 2 ) !, ,�� gal. 3 ) f c�r-c gal . <br /> B. Pump Station (if required) � l_�r'->c��.D 5 <br /> Pump make & model c��;, � L-� � i i �� (attach pump curve & <br /> literature) ; system design requires �gpm at � feet <br /> of head. High water alarm make & mo el ,�;�" ��� r�a,� ��� <br /> Outside electrical work to be completed by �installer <br /> �/electrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: � / <br /> Trenches: s.f. v Mound <br /> Depth of rock below pipe " Rock bed dimsnsions 1�'x�/ ' <br /> Drop .Boxes Sand bed dimensions �t�'x 71 ' <br /> Distribution Box Pressure Dist. Pipe Diam. l�j " <br /> Manifold Pipe Diam. �" " <br /> �. Final Cover/Topsoil to be: i! borrowed from site <br /> (show location on site plan) <br /> � trucked in <br /> *#**********#�f*******��****�**#**********#*******t#**#*#�t*****t********** <br /> mhe 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 iete, true and correct. <br /> Signature of Applicant: ��c�E� C��.c•�,, Date: �'.,?L� � S43 <br /> :dPCA Certification No. : ��7 � � � <br /> Y_ <br /> - , �'� s"�--� <br /> �} <br />