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_ <br /> • :.s�w'ec-^�^T ._.....-' ......_ ...:::.;.,.�- _- -. f2 Wrg. `�+Y r) fe-+Tv` '^."c.r �►t^- <br /> r <br /> 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 /> *************************************************************************** <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: 3 Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 1°Of) gal. 2) gal. 3 ) g al. <br /> B. Pump Station (if required) <br /> Pump make & model BEr (attach pump curve & <br /> literature) ; system design requires 194 gpm at 20 feet <br /> of head. High water alarm make & model anchor <br /> Outside electrical work to be completed by 'installer <br /> x electrician other . Insideelectrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. 1_ Mound <br /> Depth of rock below pipe Rock bed dimensions .121x 55 ' <br /> Drop Boxes Sand bed dimensions _25,,c_2/' <br /> Distribution Box Pressure Dist. Pipe Diam. 2 " <br /> Manifold Pipe Diam. 2 <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> x trucked in <br /> ******************************************s******************************* <br /> he undersigned hereby applies to the City of Orono for issuance of a <br /> eptic system installation permit, agrees to do all work in strict <br /> acordance with theordinances of the City and the regulations of the State <br /> f Minnesota, and certifies that all statements made on this application <br /> _e complete, true and correct. <br /> P <br /> ature o .. Applicant - ... � •/� (} <br /> of pph ant i �� �_.. Date 4, <br /> 'CA Certification No. : 91-3 <br />