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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $75. 00 <br /> 7t 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 /> *************************************************************************** <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> 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: p( Precast Concrete Other Manufacturer <br /> Tank Capacities: <br /> ` oo gal., 2 ) gal. 3 ) gal. <br /> 1)lc <br /> txf„f,Fcl..— <br /> B. Pump Station (if required 4v;k f> �(L;26 )1 'X117 <br /> Pump make & model C'o-14 L,Cc 3o a ` (attach pump curve & <br /> literature) ; system design requires yO gpm at /el feet <br /> of head. High water alarm make & model 1.evelf eri <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 r' " Rock bed dimensions /o <br /> Drop Boxes Sand bed dimensions 'x, ' <br /> Distribution Box Pressure Dist. Pipe Diam. ///7.- " <br /> Manifold Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> X- trucked in <br /> *************************************************************************** <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: t' Date: /27q / <br /> MPCA Certification No. : —n L7 <br />