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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (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 /> v <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 b -installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) /O-17i) gal. 2) al. 3 ) Pelfragal. <br /> B. Pump Station (if quir d) <br /> Pump make & model Q uld- L4.J ashL- (attach pump curve & <br /> literature) ; system design requires 30 gpm aj A/0 feet <br /> of head. High water alarm make & model /c m . <br /> O9tside electrical work to be completed by.P_installer <br /> V electrician other . Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions L'x 6g ' <br /> Drop Boxes Sand bed dimensions44:x757,2 <br /> Distribution Box Pressure Dist. Pipe Diam. 02 <br /> Manifold Pipe Diam. Z. " <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: 4Date: g i <br /> co <br /> MPCA Certification No. : <br />