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4 <br /> A <br /> SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $100. 00 <br /> Repair or Replace Existing System $50 . 00 <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT~ WITH THIS APPLICATION <br /> *************************************************************************** <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate 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 c--, Other Manufacturer <br /> Tank Capacities : 1) l 4 Z gal. 2 ) (u'ro gal. 3 ) 0-44 gal. <br /> B. Pump Station (if required) <br /> Pump make & model 1-A 7 d Y-0 1.4 (attach pump curve & <br /> literature) ; system design requires gpm at feet <br /> of head. High water alarm make & model l I] ,^° <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 7, Rock bed dimensions t 0 'x S Si <br /> Drop Boxes Sand bed dimensions 3s, 'xyr' <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 /> Signature of Applicant: a000'u.`. G __ <br /> Date: D <br /> MPCA Certification No. : It cl 1 <br />