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S$�TIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit 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 �ermit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMLNT WITH THIS APPLICATION <br /> ***************�********************�**********�*************�************* <br /> NOTE: Ap�licant must initial all spaces. Fill in all 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 be installing the following: <br /> A. Tanks: �Precast Concrete Other Manufacturer <br /> Tank Capacities : 1 ) 7l�'z' gal. 2 ) i�:'r gal. 3 ) io>>z� gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature) ; system design requires y�, gpm at `�_ feet <br /> of head. High water alarm make & model <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. 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. " <br /> D. Final Cover/Topsoil to be: � borrowed from site ' <br /> (show location on site plan) <br /> trucked in <br /> ******�*********�***********�*****:**********�*�****�******�*�*********�*** <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 /> -� <br /> - C_-____--- -___.___ , <br /> / c-� '] C,_ '_ <br /> Signature of App licant: C, a � �% r G�=C � Date: <br /> MPCA Certification No. : ���' ,�'�� � � <br />