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-EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />Permit Type & Pees (check one) <br />X New Construction, Full System $100.00 . . <br />_ _ 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 />t************************************************************************** <br />JOTEs Applicant must initial all spaces, <br />check all appropriate boxes. <br />Fill in all appropriate blanks. <br />Initial <br />1.^^ I have received a copy of the system design including the <br />City of Orono Septic System Approval Cover Sheet. <br />d'-2. <br />A. <br />I will be installing the following: <br />Tanks: X Precast Concrete _ _Other <br />OMric-ii'V <br />Manufacturer <br />Tank Capacities: 1) / gal. 2) I gal. 3) jyo£^gal. <br />•yJ' <br />Pump Station (if required) <br />Pump make & model /) /M'(attach pump curve S <br />literature); system design requires gpm at _ _ _ _ <br />of head. High water alarm make & model _ _ _ _ _ _ _ _ _ _. <br />Outside electrical work to be completed by installer <br />X. electrician <br />feet-^ <br />other Inside electrical work <br />must be completed by electrician. <br />C.Treatment System: <br />Trenches:s.f.K Mound <br />Depth of rock below pipe <br />_ _ _ Drop Boxes <br />Distribution Box <br />Rock bed dimensions • <br />- Sand bed dimensions/To.'x <br />Pressure Dist. Pipe Diam. / 72 <br />Manifold Pipe Diam. '2 '* <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:jt-nM Date: H <br />.-IPCA Certification No.: