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:EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> • <br /> New Construction, Full System $100. 00 <br /> /-epair 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 TiLiS APPLICATION <br /> t************************************************************************** <br /> 4OTE. Applicant must initial all spaces. Fill in all appropriate blanks, <br /> c eck all appropriate boxes . <br /> Inr/�� <br /> � �� 1. I have received a copy of the system design including the <br /> wrdlii <br /> a. lo. r.,,,/ <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: / Precast Concrete x Other Manufacturer 7f <br /> Tank Capacities : 1) /Wgal. 2 ) /l<%9 gal. 3 ) MM' gal. <br /> B. Pump Station (if re uir d) (" <br /> Pump make & models,/ 3c)=v--7 (attach pump curve & <br /> literature) ; system design requires 4,() gpm at c9-5,- feet <br /> of head. High water alarm make & model/,,,,,-, .52-,, ,--)e--- . <br /> Outside electrical work to be completed by installer <br /> _electrician other . Inside electrical work <br /> must be completed by electrician. <br /> C. eatment System: <br /> - - ches: Mound <br /> Depth of , k bel• • pipe Rock bed dimensions /e 'x�i' <br /> Drop Bo = - Sand bed dimensions 'x ' <br /> Dis •utio Box Pressure Dist. Pipe -Dram. ik " <br /> Manifold Pipe Diam. 0,2, " <br /> : . 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 /> Signature of Applicant: , ,� BaNdb.ddallf_, Date: //' - 7 / -- <br /> _ACA Certification No. : ry <br />