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- <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 /> 4OTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes . <br /> Initial <br /> y) 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> /� 2. I willp installing the following: <br /> A. Tanks: Precast Concrete Other ManufactureX ,rre <br /> ______ <br /> Tank Capacities : 1)/ CC gal. 2 ) /6 c G' gal. 3 ) /C)06'gal. <br /> B. Pump Station (if re red) i 72 47/, <br /> Pump make & model, -e- t' (attach pum curve & <br /> literature) ; system design requires 4( 0 gpm at � feet <br /> of head. High water alarm make & model r-c'/-z- . <br /> plutside 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. A/ Mound <br /> Depth of rock below pipe uRock bed dimensions /) 'x Ste' <br /> Drop Boxes Sand bed dimensions9'x 75 ' <br /> Distribution Box Pressure Dist. Pipe Diam. /z " <br /> Manif old Pipe Diam. r!' <br /> ,D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> ******************************************Al****************************** <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: ,�� Date:/ <br /> 2 < <br /> APCA Certification No. : / / // • <br /> ti <br />