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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />Permit Type & Pees (check one) <br />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 PAYNMT WITH THIS APPLICATION <br />/11fflf!ll/f ffl!!fllff lff!lf llftfll!!lf lfffflf/!l if 1tf 11f 1ff1fff!!1f 11f 11lf <br />NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />Initial <br />i. 1 have r(,ceive,� a copy of the system design i:icluding the <br />City of Orono Septic System Approval Cover Si7,eet. <br />2. I will be installing the following: <br />A. Tanks: Precast Concrete _Other Manufacturer <br />Tank Capacities: 1) .le"10 gal. 2 ) gal. 3), ^:' ' gal. <br />B. Pump Station (if required) <br />Pump make 6 model /3y .1 « '(, (attach pump curve 6 <br />literature); syst design requires T( gpm at feet <br />of head. High water alarm make 6 model <br />Outside electrical work to be completed by _installer <br />electrician other Inside electrical work <br />ust be completed by electrician. <br />C. Treatment System: <br />Trenches: s.f. Mound <br />Depth of rock below pipe Rock bed dimensions <br />Drop Boxes Sand bed dimensions -?J"x7�' <br />Distribution Box Pressure Dist. Pipe Dram -•?—,L" <br />Manifold Pipe Diam. IT - <br />v, <br />(show location on site plan) <br />C trucked in <br />!f•f!lffflflfl!♦flfffff!!!lf llfflflflfflfff�f'f�ilf!!f!!!!f!!!!f!!f!!!f!!f!f!f <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 />21 <br />Signature of Applicant: , 11� �� � Date:_�' <br />MPCA Certification No.: c <br />