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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 , <br /> �r. . <br /> Permit Type & Fees (check one) 1 <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 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 PAYMENT WITH THIS APPLICATION <br /> ****�**********************�**********************�*******�***�************ <br /> NOTE: Ap�licant must initial all spaces. Fill in all appropriate blanks, <br /> c eck all appropriate 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 will be installing the foli ng: <br /> A. Tanks: �Precast Concrete Other Manufacturer <br /> Tank Capacities: 1 ) ���� gal. 2 ) �����__gal.____3_) _ �l� gal. <br /> B. Pump Station (if r�e ui�e ) .-,��, �(�J�U�� �-"��- '��, �'� <br /> Pump make & modellx-��/�,.��1��`' ,(at�a�h�u�g-ettrve & <br /> literature ) ; system design requires gpm at I�-_ feet <br /> of head. High water alarm make & model ,c � �- °c, � "l-'��' �� . <br /> Outside electrical work to be completed by �installef <br /> electrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches : s.f. .l 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. `'i ��' <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> /(show location on site plan) <br /> l 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 app lication <br /> are complete, true and correc . <br /> ., <br /> � � <br /> � � � <br /> Signature of Applicant• /� ,�-�/ Date: �� <br /> MPCA Certification No. : ��� , <br /> O� � �sSu � <br /> R�2�- q <br />