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. P <br />.EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />Permit Type & Fees (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 PAYMENT WITH THIS APPLICATION <br />40TE: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />Initial <br />X <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 f low.i.ng: <br />A. Tanks: � Precast Concrete, Other Manufacturer <br />Tank Capacities: 1) % l% /goal. 2) 1,4V) gal. 3) 1,111,4 gal. <br />B. Pump Station (if reuir d)� <br />Pump make & mode'C "U% �s <br />(attach pump p curve & <br />literature); syste'_m design requires �mgpat T feet <br />of head. High water alarm make & model�'rrh�r <br />Outside electrical work to be completed by _installer <br />electrician _other Inside electrical work <br />m st be completed by electrician. <br />C. Treatment Sys s.f. Mound <br />Depth of rock below pipe If <br />Rock bed dimensions 'x ' <br />Drop Boxes Sand bed dimensions _'x ' <br />Distribution Box Pressure Dist. Pipe Diam. " <br />Manifold Pipe Diam. If <br />D. Final Cover/Topsoil to be: borrowed from site <br />cis (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 installatio r'it, agrees to do all work in strict <br />accordance with the ordin "cc es o e City and the regulations of the State <br />of Minnesota, and certi es t•at a 1 statements made on this application <br />are complete, true and orre <br />Signature of Applicant: <br />_4PCA Certification No.: <br />Date: <br />