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_, , __ _ <br /> . m.,,. _ ._�vti: ' - �.�- -_= ,-�- - - -- ;. _ _... .. <br /> _� <br /> . <br /> . � <br /> - __._...._ - - --- --�^-, __-- -_ _- •��..... _ .. ; � .. _�.;: _ _ ._ <br /> -:.. , _ .,- - - - -- _ -- _ - <br /> . . <br /> T-f��...�:,.,�. _ .., ._._,�_:..�.._.._;_.. --=".."` -- . .: _ _ <br /> .--- : ., . <br /> .. <br /> .-. _ _ :- -- . --- __. - <br /> ...,.,.+s-v.-:-.�:.. �- _ . .--;_ --- . :..... _._.�.,..�„_ -_�_ , _. .....� . _ ._�zaT�.6.4� _ �.�-.rrr:" -r}.�ansft-'�"�" .:r. yl��.�� ,,:�.,�,t,,.,.. , <br /> ' . . ... . .__�." ' .__ ..�..._ _ .:�. a- .._' � .. _.:.�_ 1 . .:...•�:_�._..'.„::,. . . <br /> ; <br /> S$PTSC SYSTrM PSRMIT APPI,IC�TON - PAG� 2 <br /> Per.nit Typ e & Fe�s (c�ec.� one) - � - <br /> New Construction, FuII System $75. 00. . . . . . . . ."; � . . . , �, . _ <br /> Replace Existing Systeat (1 or more new tanks & drainfield) $�0. 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 SCHEDIILE FOR NON-3ESIDENTIAL PERMIT FEES <br /> I� DO NOT MASL PAYMENT WITH THIS BPPI�IC�TION <br /> **f:tf*#**t**:**#*f*#*t****:f***#****:**:*#***:*#tf*#**tt**f*f****ttt�f**:* <br /> NOTE: Ap�Iicant must initial alI s�aces. Fill in all a�progriate blaaks, <br /> check aIl appro�riate boxes. <br /> Initial <br /> � 1. I have received a cogy of the system design including the <br /> . City of Orono Septic System A�nroval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: �Precast Concrete Other Manufacturer LU�� � <br /> Tank Capacities: 1) /U � 1 gal. 2) C�v�,� gaI. 3 ) /�v�� c� ga1. <br /> B. Pump Station (if req�xired) �3,L: f^ �O � <br /> Pump make & model /� L� �= ��v�-c,�� (attach gump curve & <br /> literature) ; systea� design requires �C�gFin at �'. fe�t <br /> of head. High water alar.0 make & model f-}�.fi'�-/c:; S�,' �>.�.�,' �;��,�� <br /> Outside electrical work to be com�leted by installer <br /> �electrician other Inside electrical work <br /> must be completed by eiectrician. � <br /> C. Treatment System: �( <br /> Trenches: s.f. '\ Mound <br /> Depth of rock below pipe " Roc?c bed dimensions () 'x ' <br /> Drop Boxes Sand bed dimensions�'x� ' <br /> Dis�ribution Box Pressure Dist. Pine Diam. " <br /> Manifold Pipe Diam. � r , " <br /> ,�"'r-�'".�`",�� <br /> D. Final Cover/Togsoil to be.' borr wed from site " <br /> •�"-- ���_"` (show location on site plan) <br /> - ._ _ �trucked in - <br /> *:***#�**#*tt***#f*****##****f***�**:*t***:*: �#******t#:**#t:#***�t**:*:t <br /> 7e undersigned hereby applies to the City of Orono for issuance of a <br /> �ptic system iastal Iation permit, agrees to do aIl work in strict <br /> �cordance with the crdinances of the City and the regulations of the State <br /> _ Minnesota, and certifies that all statements made on this application <br /> =e complete,. true and correct. . <br /> _ . . .. ___.._. <br /> .. <br /> - ----- _ . . <br /> :gnature of AFplicant: i�2� ,.� � �-�-+c�`.' Date: �U �' �� <br /> : >: � _ . .. _ -- <br /> 'CA Certification No. : �. ��g <br />