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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />Permit Type i Pees (check one) <br />New Construction, Full System $75.00. . . . . . <br />Replace Existing System (1 or more new tanks & drainfield) $50.00. . <br />Partial Replacement (replace just tanks or just drainfield) $30.00. . . <br />$0.50 State surcharge added to above permit fees <br />SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br />DO NOT MAIL PAYMENT WITH THIS APPLICATION <br />♦f�*f�*•f•s*:+r*��#:ff**��**f#�***�*t,►w:*��**t*��:�****wf*fwt�*�***w��f*w*�� <br />NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <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: j� <br />A. Tanks: precast Concrete Other Manufacturer l&C <br />4��a� <br />Tank Capacities: 1) j2CT) gal. 2)�gal. 3) gal. <br />B. Pump Station (if required) <br />Pump make & model _ (attach pump curve & <br />literature); system design requires gpm at feet <br />of head. High water alarm make & model <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: e, •%O` <br />Trenches: s.f. Mound <br />Depth of rock below pipe Rock bed dimensions _'x ' <br />drop Boxes Sand bed dimensions 'x ' <br />Distribution Box Pressure Dist. Pipe Dian. " <br />Manifold Pipe Diam. " <br />D. Final Cover/Topsoil to be: borrowed from site <br />(show location on site plan) <br />trucked in <br />The undersigned hereby applies tc 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 c e 7 <br />Signature of Applicant w �-�-� Date: <br />AP <br />MPCA Certification No.: <br />