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� <br /> SEPTIC SYSTEM P$RMIT APPI,ICATON - 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 PAYMENT WITH THIS APPLICATION <br /> ***********�********�************�****�***�**********�t**#**�:**********��* <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate 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 be installing the following: <br /> A. Tanks: �1�` Precast Concrete Other Manufacturer �t��� <br /> '�J� �� <br /> Tank Capacities: 1) �'6J'�j gal. 2 ) /f �,� gal. 3 ) � gal. <br /> B. Pump Station (if required) ,, , ,ya <br /> Pump make & model /3 /u�- G��-�- �L� (attach pump curve & L • <br /> literature) ; system design requires ��gpm at �� fee Q��-,�a) <br /> of head. High water alarm make & model. . ��.� � <br /> Outside electrical work to be completed by +installe <br /> �electrician other Inside electrical wor �'e��1`� <br /> must be completed by electrician. • l,T=elo�►' <br /> C. Treatment System: '�'ie�"""'� � <br /> Trenches: s.f. � Mound . � <br /> Depth of rock below pipe " Rock bed dimensions �d 'x�_' � �' <br /> Drop Boxes Sand bed dimensions�'x�' �x6����� <br /> Distribution Box Pressure Dist. Pipe Diam. � "L� <br /> Manifold Pipe Diam. .�- " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> � trucked in <br /> ***�******��*#*:*�*****t********��*****�r*****�����*�*:t********�**t**���**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 complete, true and correct. <br /> Signature of Applicant:(�G� � ��'i Date: �` ���i'_�� <br /> MPCA Certification No. : � �Z�/� <br />