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1 <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system design including the City of Orono Septic <br /> � S stem A roval Cover Sheet. <br /> Y PP <br /> 2. I will be installin�the followin�: <br /> A. Tanks: �Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) �cic' gal. 2) �S c'i��' jal 3) %J�/tJ �al <br /> B. Pump Station (if required) <br /> Pump make& model �o r//r i- (attach pump curve& <br /> literature); system desijn requires �/ gpm at � ,Y° � feet of head. <br /> High water alarin make & model . Outside <br /> electrical work to be completed by installer�_electrician other. <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 /> The undersigned hereby applies to the City of Orono for issuance ofa septic system installation permit, <br /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> SignatureofApplicant _-�-� Date: <br /> MPCA License No. �b �� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Rev�e���: Appa�oval �enial <br /> � �� t D � <br /> Reviewer: ��������a�C D�te: -- o? � � <br /> �eason for I�eniai: <br />