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--_1— ...mai psi..-� rr `:. y�f_ �_ t-t..a t- :�' - ::�r.�. __ .. yS S.,`. �:.T►«:�%:� ..��. _ - � �,�... ... <br />.e..i si.:._ .. T :"'.i. L.' !i..{v. _ - _ /ST�,..�i :_� �!►.R t.�� M*„.J�(•� ^•►►�!. 70 <br />7 <br />-771 7117. <br />-M'f.�`.1'.�.. r• <br />SEMP=C SYST3 .PEWaT APPLICATOR - PAGZ 2 <br />Permit Type & Fees (check one) <br />New Construction, Full System $75.00. . . . . . . <br />Replace Existing System (1 or more new tanks & drainfield) <br />Partial Reclacement (replace just tanks or just drainfield) $30.00. . <br />$0.50 State surcharge added to above permit. fees <br />SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br />DO NOT MAIL PA2WMT WITH THIS APPLICATION <br />*s�,t:fssss::::*:ss:*:::sssss::�sssoffs:::::sssssssssssssss:*::sss*sss::ssss <br />NOT8s Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <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 />2. I will be installing the following: <br />A. Tanks: Precast Concrete Other Manufacturer G <br />Tank Capacities: 1) gal. 2) gal. 3) _,00 gal. <br />B. Pump Station (if re it d 3 ( <br />p curve & <br />h <br />Pump make & model 5 (attach pum <br />literature); system design requiresy gpm at /3 feet <br />of head. High water alarm make & model 7rs' gh.�. r . <br />Outside electrical work to be completed by installer <br />electrician other . Inside electrical work <br />must be completed by electrician. <br />C. Treatment System: <br />Trenches: s.f. <br />Depth of rock below pipe " <br />Drop Boxes <br />Distribution Box <br />K Mound <br />Rock bed dimensions /O' xSr' <br />Sand bed dimensions &d'x=__' <br />Pressure Dist. Pipe Diam.,LL" <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 />ss:ssssssssssssssssssssssss:::asst:sssssss sass:ssssssssss*sssssss:ss:sfss <br />he undersigned hereby applies to the City of Orono for issuance of a <br />sptic system Installation permit, agrees to do all work in strict <br />zcordance with the ordinances 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 />:gnature of Applicant: �Cu�YuX�F' oc ��`' Date: <br />'CA Certification No.: /S 72- <br />