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SEPTIC SYSTEM PBRMIT APPLICATON - PAGE 2 I <br /> Permit Type � Fees (check one? <br /> � New Construction, Full System $100. 00 . . . . . . . . . . . . . . <br /> Repair or Replace Existing System $50.00. . . . . . . . . . . . . <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYI�NT WITS THIS APPLICATION <br /> *�*�*��*�#*��**�*�#*****�**��******�******�**�***�***�**�***�***�*�:**�*�*: <br /> NOT$: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> 2 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 b installing the following: / � <br /> A. Tanks: �Precast Concrete Other Manufacturer Cv�[ � i <br /> ��a",� <br /> Tank Capacities: 1) /2 ,�L� gal. 2) �gal. 3 ) �,av�gal. <br /> B. Pump Station (if requi ed) <br /> Pump make & mode l�,�vv K.�,a.�ir,. (attach pump curve & <br /> literature) ; system esign requires ��gpm at � feet <br /> of head. High water alarm make & model T�c,' Sf�cfc • <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 /> Tren che s: s.f. ?C Mound <br /> Depth of rock below pipe " Rock bed dimensions �'x�� ' <br /> Drop Boxes Sand bed dimensions yQ'x� <br /> Distribution Box Pressure Dist. Pipe Diam. 2 �� <br /> Manifold Pipe Diam. 2 <br /> D. Final Cover/Topsoil to be: � borrowed from site <br /> (show location on site plan) <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 i <br /> of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> Signature of Applicant: � �,Lifi�- Date: 7'-2�'�Z- <br /> MPCA Certification No. : �-�� � I <br />