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w <br />SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />Permit Type fi Fees (check, one) <br />New Construction, Full System $100.00 . <br />Repair or Replace Existing System $50.00 <br />$0.5C State surcharge added to above permit fees <br />SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT PEES <br />DO NOT MAIL PAYMENT WITH THIS APPLICATION <br />NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />Initial <br />1. <br />2. <br />A. <br />B. <br />C. <br />I have received a copy of the system design including the <br />City of Orono Septic System Approval Cover Sheet. <br />Manufacturer <br />I will be installing the following: <br />T2mks: y Precast Concrete _ _^Other _ _ _ _ _ _ <br />Tank Capacities: 1) gal. 2) gal. 3)gal. <br />Pump Station (if required) <br />Pump make & model_ _ _ _ _(attach pum{> curve & <br />literature); system design requires c/p gpm at j'? feet <br />of head. High water alarm make & model <br />(^tside electrical work to be complete by '^instSller <br />^ electrician __pother_____________. Inside electrical work <br />must be completed by electrician. <br />Treatment System: <br />_ _ Trenches:_ _ _ _s.f. <br />Depth of rock below pipe <br />_ _ Drop Boxes <br />Distribution Box <br />D. Final Cover/Topsoil to be: <br />Mound ^ <br />Rock bed dimensions //) *x>>^ * <br />Sand bed dimensions *x * <br />Pressure Dist. Pipe ^am. <br />Manifold Pipe Diam. " <br />X <br />borrowed from site <br />(show location on site plan) <br />trucked in <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 />Q <br />Signature of Applicant <br />MPCA Certification No-: AzO / J <br />Date