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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $100. 00 <br /> A 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 /> *************************************************************************** <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> eck all appropriate boxes. <br /> I gf.e6 <br /> Mgregftv <br /> 1. I have received a copy of the system design including the <br /> v City of Orono Septic System Approval Cover Sheet. <br /> 2 . I will be installing the following: � <br /> A. Tanks: J Precast Concrete )( Other Manufacturer //-/ <br /> - ank Capacities: 1) gal. 2 ) gal. 3 ) iinOgal. <br /> B. Pump Station (if rwir ) <br /> 1 Pump make & model e,/ <br /> (attach pum9yurve & <br /> W literature) ; s ste desi n requires gPm at feet <br /> /��✓rlfe of head. High water alarm make & 9c, Ch/cc.t, <br /> may 6, <br /> ��piacern Outside electrical work to be completed by emirs alley <br /> • electrician other . Inside electrical work <br /> irs = P�-. must be complete-CI- by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe Rock bed dimensions /D 'x ' <br /> Drop Boxes Sand bed dimensions t 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 /> l/ 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 correc <br /> , <br /> 001PDate: <br /> Signature of Applicant- `_1J _ ��►��,�,� � <br /> MPCA Certification No. : e" <br />