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NOTE: 'Applicant must initial all spaces. Fill is all appropriate blanks, check all appropriate <br /> boxes. <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).L�1 gal. 2) /006 gal. 3)X75 gal..' <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requiresgpm at _j:1-- 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. Treatment System: <br /> Trenches: _ s.f. - Mound <br /> Depth of rock below pipe Rock bed dimensions /b 'x Com' <br /> Drop Boxes Sand bed dimensions /,x 9� - <br /> Distribution Box Pressure Dist.,Pipe Dram. " <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 Minnesand c 'f <br /> t <br /> are complete, true and correct: es ata all statements made on this application <br /> �F � <br /> SignacureofApplica �-•� �� ti�Date:_ ��—/�22 <br /> MPCA Certification No.: - <br /> Staff Review: Appr v Denial <br /> Reviewer: <br /> . Date: <br /> Reason for Denial: <br />