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4 <br /> SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 • <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $ ! � OOOOO . <br /> Replace Existing System (1 •r more new tanks & d .infield) $50.01 <br /> Partial Replacement (replace just tan • bs •ra n e • 30 . 01 . . . <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: x Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) C gal. w�l) gal. 3 ) 42.52) gal. <br /> B. Pump Station (if reguired) w` <br /> Pump make & model / 7L/fz",4/V 14 `® (attach pump curve & <br /> literature) ; system design/requires jp gpm at Zy 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. 2( Mound <br /> Depth of rock below pipe Rock bed dimensions /c) 'x47' <br /> Drop Boxes Sand bed dimensions 'xy ' <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 /> > 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 /> 110 <br /> Signature of Applicant: ,PV �- -� Date: <' <br /> f <br /> MPCA Certification No. : 40,4 <br />