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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $75.00 . . . . . . . <br /> Replace Existing System (1 or more new tanks & drainfield) $50. 00. <br /> Partial Replacement (replace just tanks or just drainfield) $30 . 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 /> Initial <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 ) ��Zn� gal. 3 ) IG,?�J>gal. <br /> B. Pump Station (if required�/ 49 <br /> Pump make & model i (attach pum curve & <br /> literature ) ; system design requires -) // gpm at j feet <br /> of head. High water alarm make & model 14 <br /> Outside electrical work to be completed by _installer <br /> electrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches : s.f. Mound <br /> Depth of rock below pipe Rock bed dimensions 161 x zalir � <br /> Drop Boxes Sand bed dimensions,_3y,2'x <br /> Distribution Box Pressure Dist. Pipe Dia 1 , <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 <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: Date: <br /> MPCA Certification No. : <br />