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410* <br /> ;EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> ><( New Construction, Full System $100. 00 <br /> Repair or Replace Existing System $50. 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 /> t************************************************************************** <br /> 'TOTE: 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: ,C Precast Concrete Other Manufacturer <br /> Tank Capacities : 1 V�''� ( gal. 2 )/2,)J -6 gal. 3 ),,� JTOgal. <br /> B. Pump Station (if required) <br /> Pump make & model ��,,;� ��-�.--�� (attach pump curve & <br /> literature) ; system design regdires gpm at feet <br /> of head. High water alarm make & model <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 /zS 'x c' <br /> Drop Boxes - Sand bed dimensionsj, 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. / " <br /> Manifold Pipe Diam. -- " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> X <br /> 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 � 1��'21r.<< Date: (211 — <br /> APCA Certification No. : L�/� <br />