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. � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> `'S 1. I have received a copy of the system desi?n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> ��S 2. I will be installin� the followin�: <br /> A. Tanks: �� Precast Concrete _ Other Manufacturer D��-w�+� <br /> Tank Capacities: 1) ����� �al. 2) �� gal. 3) j�d gal. <br /> B. Pump Station (if required) <br /> Pump make & model �'l � `��-' (attach pump curve & <br /> literature); system desi�n requires ��� gpm at I �t feet of head. <br /> Hi�h water alarm make & model �;:��t��, - Outside <br /> � ' electrical work to be completed by installer electrician x <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. _� Mound <br /> Depth of rock below pipe " Rock bed dimensions / u 'x�"�:r , <br /> Drop Boxes Sand bed dimensions �'x,_.�.�.' <br /> Distribution Box Pressure Dist. Pipe Diam.)� " <br /> Maniford Pipe Diam. �_" <br /> D. Final Cover/Topsoil to be: � borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersijned hereby applies to the Ciry of Orono for issuance of a septic systerrz installation <br /> permit, a�rees 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 /> SignatureofApplicant: ��-�-�-u�� �� ���-- Date: � � � � " �� <br /> MPCA Certification No.: <br /> Staff Review: Approval � Denial <br /> � Reviewer: � Date: ��/�� <br /> Reason for Den.ial: <br />