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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Aeesit(check one) <br /> New Construction, Full System $75. 00 <br /> Replace Existing System (1 or more new tanks & drainfield) $50. 00 . . . - <br /> partial 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 /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> k0 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> ofle 2. I will be installing the following: <br /> G A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2 ) gal. 3 ) ____gal. <br /> ( B. Pump Station (if required) (attach pump curve & <br /> `14-c Pump make & model <br /> literature) ; system design requires gpm at feet <br /> / A' of head. High water alarm make & model - <br /> �(')3(� Outside electrical work to be completed by installer <br /> electrician other <br /> inside elec. . <br /> .. icz.1 v.or} <br /> _ <br /> must be completed by electrician. <br /> -I' <br /> C. Treatment System: Mound <br /> Trenches: s.f. <br /> Depth of rock-below pipe " Rock bed dimensions __'x ' <br /> Drop Boxes Sand bed dimensions _'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 /> 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: <br /> ,� , z ,� •-''- ";14'-r---- Date: mc)'`. 3 / 771 <br /> MPCA Certification No. : 0(3 <br />