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e <br /> ,EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> 1 New Construction, Full System $100. 00 <br /> Repair or Replace Existing System $50 . 00 <br /> Yt <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 /> r****************************t*************************************tit****** <br /> 40TE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. _ <br /> Initial <br /> _._440.2__ 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> )( t 2. I willbe �nstalling the following: <br /> A. Tanks: L Precast Concrete Other Manufacturer A�L,1S <br /> 4 <br /> Tank Capacities : 1) JZSG gal. 2.) MOO gal. 3 ) /7.r.5-Ugal. <br /> -14- <br /> B. Puma Station (if re u' red 052'%'6 <br /> Pump make & model f .,+r-,� --- �'_ (attach pum curve & <br /> literature) ; systeth design requires L/'' gpm at feet <br /> of head. High water alarm make & model 4,4-4,c, cf7'Z . <br /> Ou ide electrical work to be completed by installer <br /> electrician _other . Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> „S- Trenches: /6E9 s.f. Mound <br /> Depth of rock below pipe / 3 " Rock bed dimensions _'x ' <br /> ,..5 Drop Boxes - Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diem. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: l/ borrowed from site <br /> (show location on site plan) <br /> trucked in <br />**:rpt***ir****************************************icer***************art******:r <br />=he 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 /> Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> 8� / ?�� <br /> signature of Applicant: ���-, �G � Date: 3� <br /> LPA Certification No. : � <br /> C- • .. <br /> i <br />