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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be install' he following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) �PS� al. 2) - S!� -gal 3) gal <br /> fQ <br /> B. Pump Station (if required) <br /> Pump make&model (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 other. <br /> C. Treatment System: PJL`..) f 2e- Se-gP �� <br /> Trenches: s.f / Mound <br /> Depth of rock below pipe Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' 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 plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, <br /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature of Applicant Date: <br /> MPCA License No. <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> W 5-'G- <br /> Staff Review: Approval Denial <br /> Reviewer: Q q A4 ATT Lav I+CS at X AJ Date: ?o 0 <br /> R Apel-cA4io,4j A,112PEW,61 <br /> - 3b-0 <br />