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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> ' ew Construction, Full System $75. 00 <br /> replace Existing System (1 or more new tanks & drainfield) $50.00. . . <br /> ?artial 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 /> RTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> .itial <br /> i��al <br /> `C.v 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: / if <br /> A. Tanks: Precast Concrete Other Manufacturer C, v (l S <br /> Tank Capacities: 1) /40 gal. 2) /rd gal. 3 ) /4&) gal. <br /> B. Pump Station (if required) <br /> Pump make & model r)cP 3) (attach pump curve & <br /> literature) ; system design requires yo gpm at i .- feet <br /> of head. High water alarm make & model 2 ( <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 � S <br /> 'xS ' <br /> Drop Boxes Sand bed dimensions j'x To ' <br /> Distribution Box Pressure Dist. Pipe Diam. i 'z. " <br /> Manifold Pipe Diam. z " <br /> D. Final Cover/Topsoil to be: ,X borrowed from site <br /> (show location on site plan) <br /> - trucked in <br /> ************************************************************************ <br /> undersigned hereby applies to the City of Orono for issuance of a <br /> tic system installation permit, agrees to do all work in strict <br /> ordance with the ordinances of the City and the regulations of the State <br /> Minnesota, and certifies that all statements made on this application <br /> complete, true and correct. <br /> nature of Applicant: // vim/ Date: 1/- & - kY <br /> a Certification No. : /3 7Z <br />