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-pTIC SYS -P *SIiI' APPLICATON - PAGE 2 <br /> Pe_it Type & Fees (check one) <br /> w Constrac-ion, Full System $75. 00. . <br /> �clace Existing System (I or more new tanks & drainfield) $30.00. . . <br /> pial Replacement (replace just tanks or just drainfield) $30.00. . <br /> ,x.50 State surcharge_ added to above permit. fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERM-IT FEES <br /> DO NOT MAIL PANT WITH THIS APPLICATION <br /> -•xr:f�*�t#ff*yr�*f***#:f**f**::*:*fff**:f**�::fff**t:t*t*f*:***::**�**f*t*:� <br /> )TS: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> ;tial <br /> /3 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> rr �? <br /> 2. I will be installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) legal. 2) Legal. 3 ) /� gal. <br /> B. Pump Station (if required) <br /> Pump make & model attach pump rve & <br /> ca <br /> literature) ; system design requiresqpm at / 7 feet <br /> of head. High water alarm make & model „77 <br /> Outside electrical work to be completed by A installer <br /> ,electrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatm t S tem: <br /> Tren s: s.f. �i Mound <br /> Depth of ock below pipe Rack bed dimensions <br /> D p xes Sand bed dimensions_;%Z'x 6-0 " <br /> istrib ion Box Pressure Dist. Pipe Dif_� <br /> Manifold Pipe Diam. ,�. <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> _ (show location on site plan) <br /> _ _._ ,.._. ._.. .. . ._.. ._ trucked in - <br /> undersigned hereby applies to *the City of Orono for issuance of a <br /> :ic system installation permit, agrees to do all work in strict <br /> Zdance with the -ordinances of the City and the regulations of the State <br /> annesota, and certifies that all statements made . on this application <br /> complete,. true and correct. 9 <br /> ._. _. . . . .Applicant: .. �''2-- <br /> More of App Date:- <br /> Certification NO. : <br /> ' i <br />