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NOTE: Ap icant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> bo es <br /> 1. I have received a copy of the system design including the City of Orono <br /> 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) �l��i gal. 3) L gal. <br /> B. Pump Station (if required) <br /> Pump make & mode ;,�1�/� � �� (attach pump curve & <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make & model "_ Outside <br /> electrical work to be completed by installer electrician <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatn nt System: <br /> enches: s.f. i Mound <br /> Depth of knock elow pipe IfRock bed dimensions IZ2 <br /> Drop'Boxes Sand bed dimensions <br /> Distr Sution 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 undersigned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minneso , and certifies that all statements made on this application <br /> are complete, true and correct. <br /> SignatureofApplican Date: x'02 0 <br /> MPCA Certification No.: ? <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />