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ii2.S�brn� <br /> G4J1\AV, CCAr((2 <br /> SEPTIC SYSTEM PERMIT APPLICATION <br /> ly) <br /> %.rystai Bay,Mn 55323 <br /> JOB SITE ADDRESS 3 85's U J A 4,oW/J 'RO At 6 <br /> Occupancy Type: Residential Commercial Other <br /> Permit Type: Ne*or Replacement System $100.00 `P/00• Sa <br /> Repair Existing System $ 50.00 <br /> (Tanks or Drainfield) <br /> $0.50 State surcharge added to above fees <br /> * See fee schedule for non-residential permit fees <br /> Owner's Name: *TOP0 •- M: Ch&fit KI" f Phone Number: 765- 4 7$ •3 16% <br /> Mailing Address: IS 7o 8 36 4!! Apt City: V`I11464-#i• Zip: ESA's 6 <br /> Contractor's Name: Phone Number: <br /> Mailing Address: City: Zip: <br /> *** <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION*** <br /> GENERAL INSTRUCTIONS <br /> 1. Applications for septic system permits may be mailed or submitted in person at the City <br /> Offices; however, permits will not be mailed out. The permit must be picked up in person <br /> at the City Offices and work must not begin unless the permit card is on the job site. <br /> • <br /> 2. Permits will be issued only to contractors holding a Minnesota Pollution Control <br /> Agency(NTCA) Septic System Installers License. <br /> 3. All work must be done in accordance with the approved septic system design. Design reports <br /> are not considered approved unless accompanied by the "City of Orono Septic System <br /> Approval" cover sheet signed by the City Inspector. <br /> 4. The following inspections will be required for all septic systems: <br /> A. Pre-installation site inspection to include inspector, installer, and general contractor. <br /> B. Tank installation prior to covering. <br /> C. Drainfield trench installation prior to covering. For mounds, inspection is required after <br /> rough up but prior to sand placement (sand will be jar tested for silt content), and again <br /> during pressure distribution piping installation in the rock bed. <br /> D. Final inspection to verify proper final cover depths and to verify that all pump stations <br /> (where required) components are functional and comply with codes. . <br /> 5. Individual holding 11KAInstallers License shall be present during all inspections. :' 24-hour <br /> notice is required for all inspections. <br />