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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2A P. <br /> Permit Type & Fees (check one) <br /> _New Construction, Full System $75.00. . . . . . . . . . . . . . . . . . <br /> ePartial <br /> place Existing System (1 or more new tanks & drainfield) $50.00. .Replacement (replace just tanks or just drainfield) $30.00. . <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 /> 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 Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal. 3) _,gal. <br /> B. Pump Station (if required) <br /> (attach pump curve <br /> Pump make & model & <br /> literature) ; system design requires gpm at feet <br /> of head. High water alarm make & model <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: Mound <br /> Trenches:_ s.f. <br /> Depth of rock below pipe Rock bed dimensions <br /> Drop Boxes Sand bed dimensions L4 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 plar <br /> trucked in <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. C <br /> Signature of Applicant: <br /> Date: d <br /> MPCA Certification No. : ��� <br />