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� ' <br /> >EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type � Fees (check one) <br /> �ew Construction, Full System $100. 00 . . . . . . : . : : : : : . <br /> Repair or Replace Existing System $50. 00. . . . . . <br /> �0.50 State surchar�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 /> t�t�t�t�tfir�rtit�tftir�rit*�tirftt*�t�t*�r�*�t*�t*�t***�t�f*�t�r�tdt�t�t�r�t��tt�tt�tir�t�t*�t**�tt**�*��t�t�tff�t <br /> :dOTE: Applicant must initial alI spaces. Fill in al.l appropriate blanks, <br /> check all appropriate boxes. _ <br /> Initial <br /> s' Z. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> Q . s 2. I will b� e�nstalling the following: <br /> A. Tanks: V Precast Concrete Other Manufacturer <br /> /�oo <br /> S�o 0 <br /> Tank Capacities : 1) 'a'�gal.. 2-) a0 gal. 3 ) ��? gal. <br /> B. Pump Station (if required) <br /> Pump make & model �J [� S (attach pump curve & <br /> Iiterature) ; system design requires gpm at feet <br /> of head. High water alarm make & model S; • � <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: � � �p �' � <br /> Trenches: s.f. V rlound <br /> Depth of rock below pipe " Rock bed dimensions� 'xy�' <br /> Drop Boxes - Sand bed dimensions�'x o0' <br /> Distribution Box Pressure Dist. Pipe Diam.1,�" <br /> Manifold Pipe Diam. ,��► " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> �trucked in <br /> ��*�***f�*��f*�****tt**#**t**�*#tt**�**t***#***t:****�t*t*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 al.l statements made on this application <br /> are comp lete, true and correct. � � <br /> Si ature of A licant: Date: .� � <br /> � PP <br /> _dPCA Certification No. : � / s� � � <br />