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� � <br /> SEPTIC SYSTEM PERMI7' 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 adeied to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> *******�t�**********�*�**��r***�*********�t��*��**:***#�t***��*�***��**�**t# <br /> NOTE: Applicant must initi.al all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <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 Other Manufacturer <br /> Tank Capacities: 1) 1�ga1. 2 ) 1�ga1. 3 ) ��al. <br /> B. Pump Station (i.� required) <br /> Pump make & inod�I�;�� ( L�.:'c=c� �,� � ��1 (attach pump curve & <br /> literature) ; �;,ystem dE�sign requires ( gpm at � feet <br /> of head. High w��.ter alarm make & model <br /> Outside electric�l �vork to be completed by _installer <br /> �electrician r,ther Inside electrical work <br /> must be complete3 by electrician. <br /> C. Treatment System: <br /> Trenche s: s..f . ��i Mound <br /> Depth of rock below� pi�pe " Rock bed dimensions l�'x ��' <br /> Drop Boxes Sand bed dimensions �'x��f/ <br /> Distribution Box Pressure Dist. Pipe Diam.�l'z_" <br /> Manifold Pipe Diam. � " <br /> D. Final Cover/Topsoil tc be: borrowed from site <br /> ( show location on site plan) <br /> trucked in <br /> *******��****#****�at************ta�*i►***�*******#��t**�*****�****�*t*�*��*** <br /> The undersigned hereby applies tc� the City of Orono for issuance of a <br /> septic system installation perrnit, agrees to do all work in strict <br /> accordance with the ordinances of tY.e City and the regulations of the State <br /> of Minnesota, and certifies that a:l.l statements made on this application <br /> are complete, true and correct. <br /> � <br /> Signature of Applicant: -%� _ � `-U��—� Date: �� — Z-� � �`z—_ <br /> MPCA Certification No. : <br />