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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> ... . ,.. <br /> Permit Type & Fees (check one) <br /> � �N � 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 drainfie3d ? $30. 00. . . <br /> $0. 50 State surcharge added to above Fermit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> ***��*******************************************�***************�****�***** <br /> NOT$: Applicant must initial alI spaces. Fill in al 1 appropriate blanks, <br /> c eck all approFriate boxes. � <br /> I 1 <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 wi 11 be insta l ling the fo 11 ng: <br /> A. Tanks: �Precast Concrete Other Manutacturer <br /> Tank Capacities: 1) ��gal. 2) ��/6� ga. 3 )_ �� gal. <br /> {,� ��(.c_�� �-� <br /> B. Pump Station (if re ui;e_� UJ�d�I ` � <br /> Pump make & mode � � . a e & <br /> literature) ; system design requires gpm at / ` feet <br /> of head. High water alarm make & model � , s- ,c '� C' . <br /> Outside electrical work to be completed by nstalle <br /> electrician other Inside electrical work <br /> must be completed by electrician: <br /> C. Treatment System: <br /> Trenches : s.f. 1 Mound <br /> Depth of rock below pipe " Rock bed dimensions J'�'xy�'� <br /> Drop Boxes Sand bed dimensions��'x '(�' <br /> Distribution Box Pressure Dist. Pipe Diam.�" <br /> Manifold Pipe Diam. ,��r, ' <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> �(show location on site glan) <br /> trucked in <br /> ****#�****��:*#�*******:*:*:***********�:*#�***:**��***************�***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 app lication <br /> are complete, true and correc . <br /> ., <br /> � � � <br /> Signature of Applicant Date: �� <br /> MPCA Certification No. : ��� , <br /> O� �p ��S'Su � <br /> 2�2�- q <br />