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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <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 PAYMENT WITH THIS APPLICATION <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Z <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 ) %/l./)gal. <br /> B. Pump Station (if required) _ <br /> Pump make & model ,� , ; c (attach pump c rve & <br /> literature) ; system design requires gpm at _:� feet <br /> of head. High water alarm make & mo e 1 <br /> Outside electrical work to be completed by installer <br /> �electrician other Inside electrical work <br /> st be completed_ by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensions 'x,��i�' <br /> Drop Boxes Sand bed dimensions _'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. of <br /> Manifold Pipe Diam. It <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 <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,. <br /> Signature of Applicant- <br /> Date: tel% `ate <br /> MPCA Certification No. : � � <br />