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� � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes._ <br /> ; 1. I have received a copy of the system design including the City of Orono � <br /> i <br /> Septic System Approval Cover Sheet. <br /> \ 2. I will be installing the following: <br /> `" A. Tanks: � Precast Concrete Other Manufacturer � <br /> Tank Capacities: 1) � gal• 2) � gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by installer electrician <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> � Trenches: ��s.f. Mound <br /> De th of rock below pipe �" Rock bed dimensions 'x ' <br /> � Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> ,� <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: � bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct <br /> � -- _ <br /> — _ c �� �, <br /> SignatureofApplican: v'^'� � '�'�' � � Date: �' � � <br /> MPCA Certification No.: <br /> Staff Review: Approval � Den'al <br /> Reviewer: �>--�'� Date: ���7�� <br /> Reason for Denial: <br />